Tuesday, February 7, 2017

That SAITM problem: What to do and what not to do

The Sri Lanka Medical Council (SLMC) is a regulatory body. The Government Medical Officers’ Association (GMOA) is a union. The former has to comply with the law, the latter can campaign against the law. The former is (supposedly) free of politicking, the latter (again, supposedly) is not. It is to be expected, then, that when the Court of Appeal rules in favour of a private medical school, the latter rises up, encourages the University student movement in the country to campaign against it, and goes to town distributing leaflets, pamphlets, and what-not to clarify its stance. Doesn’t make it perfect, but doesn’t trivialise its actions either.

Our students have always fought to protect our education system. They have protested against measures taken by successive government to turn it into a commodity and have, at an exorbitant cost to themselves and their families, succeeded. Nothing wrong there, particularly when considering the fact that most of those measures have tried by and by to transform education into a privilege for those who can afford it. Free education has become to us what the NHS has become in the United Kingdom, but that has not stopped our Ministers from setting up ad-hoc Colleges which have, thanks to the student movement, been absorbed into our University system (I am talking about the short-lived North Colombo Medical College).

That is why the student body, not just the Inter University Students' Federation (IUSF, more popularly known as Anthare) should be heard: not because they remain stakeholders in our education system, but because they know how much at risk education is in a world where it’s being sold out to capital interests. This week’s article, on SAITM and the crisis it compelled and continues to compel, delves into two broad issues. Before we get to the crux of the matter, we need to go through these issues and try to resolve them.

Two issues, two allegations

The first issue is the rationale for the opposition to the Malabe campus. The campaign against private medical Universities did not begin by condemning private education. It began by pointing out that the Malabe campus did not possess what’s needed to qualify the students who graduate from there. Put simply, the doctors who graduate aren’t qualified enough to practice here.

Two allegations are pertinent on this count. Allegation Number One is that the minimum entry requirements at the campus aren’t enough. It’s ridiculous to suggest that private Universities only attract those who obtained low A Level scores, because that assumes that those who fail the local A Levels are all dropouts who don’t deserve a second chance. This, however, doesn’t belie the fact that a great many of such entrants who enter the campus did obtain such low scores.

Dr Sameera Senaratne, the CEO of SAITM, observed in a media briefing last week that when the University was begun in 2009, the admissions policy was based on the criteria laid down by the University Grants Commission. Initially this meant it was open to students who obtained three S’s at their A Levels, but as time went by (according to Dr Senaratne) the minimum requirement was increased to entitle students with two C passes and one S. A fair enough counterargument.

Allegation Number Two is worse: that SAITM does not possess enough to be an accredited medical institution in the first place. In a speech delivered at a foundation session of the Sri Lanka Medical Association (SLMA), Professor A. H. Sheriff Deen lays out four prerequisites to a certified medical school: a teaching school, a proper curriculum, capital, and permission to start a degree awarding institution. On all these counts, Professor Deen contends, SAITM lacks what it takes to be accredited by the SLMC.

How much of a problem is this? Consider the allegation that the students at SAITM aren’t given adequate clinical training. What constitutes adequate clinical training? Experience at a teaching hospital, of course. Most of those opposed to SAITM, naturally, are opposed to it because its students are provided with PRIVATE clinical training, cut off from the State and therefore from its requirements for aspiring medical practitioners.

What is SAITM’s response to this? The fact that from its inception, attempts to link up with the Homagama, Talangama, and Avissawella hospitals were opposed by certain student unions, and the fact that it was this which precipitated the establishment of a private training facility (supposedly the largest in Sri Lanka). A fair response, one can surmise, but then if the Sri Lanka Medical Council (SLMC) has objected to the private training facility, and given that the Council IS a governing body (unlike the GMOA), is it enough to counter those hell-bent against it?

The rationale of those opposed to the Malabe campus, therefore, has less to do with the idea of private education than the shortfalls of the institution. Moreover, they will point at the ERPM (Act 16) examination, which students returning from foreign Universities must sit through if they are to practice medicine, and at the fact that less than 20 percent pass it.

They will also contend that even in 2015 and 2016, of the 1,260 well qualified local students who sat for it, 60 failed and had to be pruned out. Their argument is that in a context where even these bright students will not be given "consolation" MBBS degrees, how is it fair that capital be used to creep in and bypass the system? The answer, as always, depends on the way you perceive the issue. I have my caveat, though: Act 16 was designed specifically for students who sat for their medical exams outside the country. Strictly speaking, the students at SAITM are not from outside. Their degree and qualification is, but that’s another story. And another can of worms.

This belies a second, bigger issue: the inability of those opposed to structural deficits of a private establishment to distinguish between opposing those deficits and opposing what the establishment is based on: in this case, private education. Money doesn’t always coexist with merit, yes. The minute you let education be decided by capital, you artificially and immediately equate the top-scorer with the low-scorer. Does this mean that private education should be boycotted? By no means.

Elites and the original sin

If the State operates on the premise that education is a right for all, then the private sector should theoretically be allowed to go ahead with the principle of freedom for education: that is, freedom to enter a fee-levying institution if the student and his/her family are willing to pay their way through. The problem here, however, is to do not with the nature of private education, but with the nature of the sector in which SAITM operates: medicine. Pithily put, a field that involves the health and welfare of people should not be housed by people who have questionable credentials and money.

I know the argument of those who support private education: that medicine has become the monopoly of old, unwholesome, and bureaucratic elites. Elites, however, come in different shades, and as a friend of mine once told me, the one thing dividing the bureaucratic elite from the moneyed elite is the point that the latter are self-perpetuating. Nowhere is this truer than in the medical field.

And it’s not just about private medical campuses: it’s about the fact that even government doctors fudge it at their job, either joining lucrative careers in the private sector or opting for the channelling system and entering private practice. I fervently believe that an institution that wittingly or unwittingly qualifies a self-perpetuating social class must, of necessity, be vetted through the relevant governing body. I believe also, however, that inasmuch as moneyed interests must be cut off entirely, this does not shield the members of the GMOA and governing state institutions who politicise the issue beyond permissible limits and indulge in the same monetisation of their profession that they condemn in their press briefings.

I believe Professor Carlo Fonseka put it best: that no less a figure than Karl Marx never underestimated the potential of free markets doesn’t in itself immunise private institutions from national vetting procedures. Profits matter, even in a government institution, but to make them the defining principle in education, particularly in a context where even the State suffers from intrusions by moneyed elites, is neither proper nor fair. We live in a society where equity is seen as more important than academic achievement. Given that profits (should) rank below academic achievement in the general order of things, isn’t it reasonable that for education to be properly maintained in the country, merit must be the overriding factor?

The SAITM side of the story

All this, of course, is what those opposed to SAITM would say. What of SAITM’s side of the story? An unbiased, sober reading of the issue reveals certain flaws with the GMOA, the union body of the SLMC. For instance, as Professor Deepthi Samarage said in an interview with "Ceylon Today" on January 30, the SLMC refused to grant even provisional registration to students graduating from the campus, on the pretext that the power of the 10-member Expert Committee tasked with ascertaining the credentials of the campus to make recommendations to SAITM was invalid.

Here’s what Professor Samarage said (I am quoting from the interview): “Nine members of that team made a comprehensive review over two and a half days. They produced an initial report to the Council, which stated (that) SAITM graduates can be registered after fulfilling a few SLMC recommendations. The SLMC recommendations included a one month clinical training for the students in a busy State hospital in major disciplines and to conduct a clinical examination for SAITM graduates. This is what was conveyed to SAITM at the wrap-up meeting by the review team.” In other words, the power to recommend, which wasn’t questioned before, was laid aside AFTER the meeting. By whom? The GMOA? The SLMC? Certain vested interests?

We can never really be sure. We can, however, infer. The fact is that SAITM has tried, from its inception, to work with the State. The fact is that the leading student body in our University system has opposed it, and not always for innocent reasons. As I mentioned before, that body has done a good job of confusing between opposing SAITM’s perceived deficiencies and opposing private education in general.

To be sure, that doesn’t mar their concern. But it does mar their legitimacy. It also rebels against their vision for a freer education system, by which I am referring to the prerequisite that should exist in any education system, CHOICE. If choice is being denied to those who dropped out of the local University system, what better term do we have for their opponents than “hypocrites”? And if we are to take this campaign forward on the basis of its concern for standards, aren’t we doing everyone a disservice by marring the name of an institution when rational discussion would do? The answer, I believe, is self-evident and there for all to see.

That is why, inasmuch as I personally have reservations about private education, I think the Court of Appeal did the correct thing by affirming the writ applications of Malshani Suraweeraarachchi and Dilum Sooriyarachchi, both of whom had their applications for registration as medical practitioners allegedly rejected by the SLMC. On the other hand, those who have a problem with the January 31 ruling contend that the law is not the final resort: that other methods of campaigning against the final verdict exist. They can appeal higher at the Supreme Court, but for now, the IUSF, the GMOA, and a section of the SLMC seem to have gone for the “outside the courts” strategy: stage protests, make noises, and compel our attention.

The way I see it, however, this will not work for them or for us. The public they are trying to reach at are diametrically opposed to the public they are reaching. Of the latter, the largely middle-class, urbanised, and affluent social class of the country figure in. They are not opposed to private education, even though they may be beneficiaries of free education (after all even students in State Universities are against the IUSF). Of the former, the not-so affluent, village schoolchild and teenager figure in. The IUSF is trying to campaign for them. They are not reaching them. Also, given their past record (in particular, the GMOA's notorious demand for car permits and affirmation of private practice and channelling), their credibility seems to be waning. Tragically.

Charting a solution

So what’s the solution? First and foremost, the IUSF, the GMOA, and the SLMC must elevate the quality of their protests. They must understand that given our affirmation of private education, the people will not rally behind them for long. They must take their campaign from vilifying SAITM unconditionally to pointing out the flaws in both the private and public sectors. SAITM may or may not have committed a sin, we do not know. It did not commit the original sin, however. For that, the people behind the current protests must look elsewhere: at the crass monetisation of their profession and their own "flexibility" when it comes to opting for the private sector.

Secondly and more importantly, their campaign must be less concerned with virulently opposing private education than with trying to link up the state and private establishments in a way that is conducive to both parties. This has already been done. We mustn’t privatise education overtly, but for those who can afford and are willing to pay through, there must be avenues open. Whether or not they flunk their exams, whether or not they rank higher than products of the local system, are questions to be answered later. If they are the idiots we conveniently see them as, they will peter out. If not, the regulatory authorities will correct them.

When I wrote on higher education and private universities to this column (“Plastering problems: Universities, private education, and the bigger picture”), I contended that there were two ways of looking at education: that it’s a right and that it’s a commodity. About a week later, R. M. B. Senanayake in a reply titled “A false distinction” countered what I wrote by saying, basically, that rights could also be commodities, to be marketed and sold based on a theoretically equilibrium price.

Now Senanayake has always been a defender of the free market (which is at odds with his role as a defender of individual and collective rights, though that’s another issue), and I am not, but I wonder: have we been so enamoured of the dichotomy between rights and commodities that we tend to lose ground by slinging mud at the wrong places? The SAITM issue, and how it will eventually be resolved, may prove to be a litmus test on that count.

Written for: Ceylon Today, February 7 2017