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Sunday, 03 July 2016

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Agony & Anger

SAITM: Student aspirations confront qualifying standards:


With two court hearings pending in the coming week, the first batch of graduates from the South Asian Institute of Technology and Medicine (SAITM) are fighting back to be recognized by the Sri Lanka Medical Council ( SLMC) and allowed to work in Sri Lanka. The latter however, states SAITM doesn't meet the prescribed standards.

Following graduation from SAITM, the issue arose when a student attempted provisional registration at the SLMC, for internship appointments. For State university graduates, the SLMC provides the Provisional Registration before appointing them on the internships, following which permanent registration could be applied for by the student. However, this student was denied registration claiming that SAITM is not a recognized degree provider in Sri Lanka.

Separately, the students have now filed a Fundamental Rights petition in the Supreme Court seeking an order to redraft the Medical Service Minute to enable non-state universities and non-state recognized degree awarding institutes within Sri Lanka, to be recruited to state medical service. The Supreme Court has directed the Attorney General to ascertain from the Health Ministry and the Public Service Commission whether Section 29 of the Medical Ordinance could be amended.

However, the lack of a favourable nod from the SLMC is holding down accepting the SAITM graduates into the local healthcare system. The Higher Education Ministry and the University Grants Commission carry a conditional clause stating that their approvals are invalid unless the SLMC recognizes the private degree providing institute. Gazette No 1824/21 dated August 22 2013 states , "In the case of study program in medical sciences, the teaching hospital to which the student has access and provided with clinical training, must conform to the standards stipulated by the Sri Lanka Medical Council".

SLMC Report

SLMC Official Report to the Health Minister on September 4 2015, on the suitability for recognition of graduates of SAITM, to be registered under the Medical Ordinance, stated that the degree awarded by SAITM should not be recognized for the purpose of registration under the Medical Ordinance.

The report stated, according to information supplied by SAITM in 2015, of the 12 batches consisting 846 students admitted to SAITM since its inception, the first seven batches, with 363 students, were undergoing clinical training in the wards of the hospital set up with the specific purpose of giving clinical training to students of SAITM, called,

'Neville Fernando Teaching Hospital', at the time, and faced serious inadequacy in the clinical training of its students.

"Clearly so many students having access to so few patients cannot be expected to receive adequate clinical training," the report reads, and that it is a 'startling contrast' to what obtains in the state medical faculties.

Students' views

Further, writing to the Attorney General on October 23, 2014, the Secretary to the Ministry of Health informed, while the Minister is willing to facilitate the required clinical training at a state university, "SAITM remains responsible to adhere to all laws and regulations... and fulfil the requisite standards applicable and ... recognized by the Sri Lanka Medical Council and or any other relevant authority."

The government however, is yet to establish a framework to include the newly accredited schools into the system. A student representative of the SAITM graduates, rquesting anonymity told the Sunday Observer that as far as they are aware, SAITM is a degree providing institute recognized by the Sri Lanka University Grants Commission and the Higher Education Ministry.

"Therefore, legally, we should be allowed to work in Sri Lanka. We really hope we will be allowed to," he said.

Initially, SAITM signed a Memorandum of Understanding with the Homagama General Hospital in 2012 to facilitate clinical training for its students, but after a day of training, it was discontinued as protests escalated.

The later attempts to affiliate Sri Jayawardenapura Teaching Hospital with SAITM to conduct clinical training too got watered down end of last year. Currently, students of SATIM are allowed to undergo the mandatory clinical training at Asiri, Nawaloka, Lanka Hospitals as well as the Neville Fernando Hospital.

The students assured they are exposed to the same sicknesses a state medical student in a state hospital would be, though not in the same numbers.

"It will be similar to accepting students from foreign medical degrees, who haven't had the same exposure a local medical student would," they argued. The political motives aside, they said their desire is to work in Sri Lanka, not in Russia, where SAITM held affiliation with a university for the first four years since establishment.

Academic staff

Students claimed, compared to facilities provided at medical faculties in state universities in rural areas, SAITM had better facilities. Further, despite their affirmation that Section 19A of the Medical Ordinance doesn't specify minimum standards to allow medical students from private universities to enter the healthcare service in Sri Lanka, the said Section also specified that the SLMC can conduct inquiries, and investigations to determine whether "the staff, equipment, accommodation and facilities provided by such university or institution for such course of study, conform to the prescribed standards.

Nevertheless, the students are hopeful, as their legal counsels have confirmed that " it's a clear-cut" case."

SAITM academic staff were unavailable for comment. However, when contacted a fortnight ago, Head of Department of Forensic Medicine, SAITM Prof. Ananda Samarasekera said, under the Medical Ordinance, the SLMC "has no right to legally refuse registration."

"The Medical Council has to act in accordance with the rules specified in the Medical Ordinance. Under section 29 of the Ordinance MBBS degrees awarded by a recognized state or degree awarding institution are equal in terms of the law.," He explained that the SLMC has guidelines but not regulations laid down on paper, approved by Parliament and gazetted.

"The committee had reported to the Health Ministry the deficiencies based on their guidelines," he noted. Asked of the predicament of the students, he assured the management would ensure the students have a future..

"We have not achieved anything easily at SAITM as we had to go to courts often. This time too it is no different," he said.

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[SLMC STANDS FIRM]

As undergrads from both, state universities and the Malabe private university ( SAITM) cross swords over the contentious issue of whether SAITM students should be given the licence to practise , the deciding Council - the SLMC revealed, it would stand by the decision of the ten member Committee which visited SAITM this month on an inspection tour.

President , SLMC , Professor Carlo Fonseka told the Sunday Observer , Saturday, the team headed by one of Sri Lanka's foremost authorities, Professor Rizwi Sheriff , had found that little had been done to address the area of clinical training. " Lack of adequate clinical training will adversely affect patient safety", he said. Secondly, unlike in a general hospital setting where students are exposed to a wide spectrum of diseases, SAITM students had access only to a very limited mix of patients. On these grounds the Council concluded that the Malabe university was not geared for patient safety which is the ultimate duty of the SLMC, " Prof. Fonseka said. " It was the unanimous decision of the Committee that students who qualified from an internal examination at the College, should not be given registration and the licence to practise by the SLMC.

He alleged, around 183 students had quit, " after they realized they had been cheated with false promises. In fact most of the claims made by the Founder of the College, Dr Neville Fernando, are not true. Wittingly or unwittingly the public have been deceived", he charged.

He said, this being the first private medical college in the country, it was doubly important that the highest standards in medicine be maintained. He also noted that when the very first private medical college, the North Colombo Medical College at Ragama was set up in 1981, the first thing the College of General Practitioners did was to build a proper hospital on government land. However, this is now part of the Kelaniya University after it was nationalized.

Asked about the fate of the students who had spent over seven years studying at the College, he said , " The SLMC has already addressed the matter and it is something that has to be negotiated".

Meanwhile, the Government Medical Officers Association ( GMOA) , the largest medical trade union in the island, has threatened to conduct a leaflet campaign on Monday followed by an all island token strike on July 4 from 8 a.m.-12 noon to convey their stand on the issue. GMOA spokesman Dr Navin de Soyza told the Sunday Observer, " Our message is addressed to all parties who have vested interests in this issue including politicians, who collectively are trying to harm patients' rights. The SLMC has the sole responsibility of maintaining quality patient care. Any attempt to encroach on their territory will affect the SLMC and in turn patient care."

He said, all unions in the health sector , the doctors' association, and medical students' union have joined hands in this cause, and will take to the streets tomorrow.

" If after this, we see further pressure by politicians in this matter, we may have to resort to drastic measures", he warned.

Sri Lanka Medical Association ( SLMA) sources when contacted refused to comment as a court case was pending.

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