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Calling applications for MBBS!

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A file photo of a university teachers’ protest against the KDU’s involvement in civilian education.

Introducing fees for medical education under military protection

By Ramya Kumar

Earlier this month the Cabinet approved a proposal presented by the President (as Minister of Defence) to admit fee-levying local students to the medical faculty of the Kotelawala Defence University (KDU). Thereafter, the KDU posted a call for applications from local students (‘day scholars’) to its MBBS programme with a May 5th, 2024, deadline—barely two weeks after the call appeared on the KDU website.

Medical education is delivered by 13 state medical faculties, 12 under the purview of the University Grants Commission (UGC), plus KDU. Students who obtain the required Z scores at the local A/Ls are eligible for admission to the UGC medical schools on a non-fee levying basis, with a limited number of seats (up to 5%) open to international students who pay USD 62,500 (USD 12,500×5) for their MBBS. KDU’s medical faculty, functioning under the Ministry of Defence, admits military cadres, along with a growing number of fee-paying international students and non-resident Sri Lankans. In other words, none of the existing state medical faculties, including KDU, have enrolled fee-paying local students to this day.

Expansion of private/fee-levying medical education has been resisted by student movements and others concerned about quality of/equity in medical education. In 2021, the government tried to stealthily introduce fee-levying medical education through the Kotelawala National Defence University Bill, which, if enacted, would have permitted the enrolment of local medical students to KDU on a fee-levying basis. Now, with apparently no regard for the law or due process, the Cabinet has approved the President’s proposal, which, if implemented, will drastically alter the landscape of medical education in the country.

Admission criteria

The KDU website lists the admission criteria for its MBBS programme for local day scholars. They should be “unmarried” Sri Lankan citizens in the age group 17-24 years who have completed the G.C.E. (A/L) examination in the year 2022 (or local/foreign equivalent in 2023) and followed the Bio-Science stream (Biology, Chemistry and Physics) and obtained a minimum of two Credit Passes (C) and one Simple Pass (S) (or equivalent at the Cambridge/Edexcel examination) in one sitting, as specified in the Minimum Standards of Medical Education.

These admission criteria expand the pool of eligible candidates by a sizeable proportion since all students with two Cs and an S in bio-sciences may apply. However, the KDU provides very little information about the process they will follow to select candidates (how many?) from this very large pool, except to say that it will involve shortlisting applicants based on their Z score /grades and a “structured selection interview” where the Board of Management will hold “exclusive rights” in selection.

Who will have access

The five-year course will levy LKR 2.5 million per year for five years, amounting to LKR 12.5 million, the equivalent of about USD 42,000. The call for applications does not refer to scholarships or grants for those who may not be able to afford the fees—aspects emphasized in the government’s proposals to expand private higher education detailed in the controversial National Education Policy Framework (NEPF). Apart from the privileged students whose parents can easily afford the fees, others will also be able to sell their assets and take on debt to pay for a MBBS degree. Yet, the application process will be biased in favour of students from elite backgrounds who are better trained to navigate interviews and speak in English.

Indeed, medicine has become an elite profession in many countries due to interview processes that rank applicants based on “soft-skills” and involvement in extra-curricular activities, community service, and other achievements—opportunities that are usually available to a certain class of people. Meanwhile, in Sri Lanka, a phone call to the KDU’s Board of Management from ‘someone who knows someone’ may increase the chances of some candidates securing seats over others. It is widely known that the North Colombo Medical College (NCMC) and SAITM became lodestones for the offspring of doctors.

Questionable justification

With several private medical schools undergoing the Sri Lanka Medical Council’s (SLMC) vetting process, privatizing medical education is justified by politicians, medical professionals and other interlocutors, as a solution to the mass exodus of doctors to greener pastures. Whether the expansion of opportunities for fee-levying/private medical education will actually address the medical brain drain is questionable. For one, it is unrealistic to anticipate that fee-paying medical graduates will remain in the country when lucrative career opportunities are abundant in the West. Even if they do remain here, with hefty fees and the debt incurred to pay them, it is unlikely that they would opt to serve in the public system in remote areas like Padaviya or Puthukkudiyiruppu, where private practice will be limited.

Two strategies are currently used to retain medical professionals in rural areas: the district quotas and mandatory post-internship appointments. First, the district quota system, an affirmative action policy implemented by the UGC, tries to compensate for the deep-seated urban-rural disparities that choke the general education system, and also supports rural retention because medical graduates recruited from these areas are more likely to serve in their home districts/provinces. Second, the Ministry of Health requires all the newly registered doctors it employs to complete a post-internship appointment at an allotted institution, ensuring a widely dispersed medical workforce. Such mandatory service requirements can be implemented at this time because the public system is still the primary employer of medical professionals in the country. Privatising medical education alongside state-incentivised expansion of the commercial hospital sector can facilitate brain drain from public to private, creating a dearth of physicians for the public sector, especially in rural areas, as has happened in India, Thailand, and Malaysia.

There is also the argument that permitting local students access to fee-levying medical education will save the country foreign exchange. Although expanding opportunities at state medical faculties may do this to a certain extent, the government aspires to attract foreign investors into the higher education sector. As stated in the NEPF, “Limits to ownership by foreign investors in Higher Education and Skills Development shall be removed with an investment threshold to attract high quality institutions.” In reality, international universities are driven by profit to be incurred locally and channelled overseas.

‘Strategic planning’

The government has craftily planned its strategy to expand private medical education post-Aragalaya. While state funding for state universities has been slashed to new lows, university administrations have been directed to self-generate funds through fee-levying degree programmes. The slightest form of protest by the student movement has been quickly stifled with many medical students and others arrested or facing intimidation from the military and law enforcement authorities. The state’s propaganda machine has painted a picture of perpetually protesting students and self-interested university teachers. Middle-class sentiments regarding state universities are at an all-time low with the Colombo elite vocally denigrating state universities and their graduates, while promoting private higher education.

Although there is wide consensus that the advent of private medical schools should not affect the delivery of state MBBS programmes, there are no mechanisms in place to ensure this. The SLMC’s accreditation standards consider state medical schools and others on par with each other, and the government has failed to take effective measures to strengthen medical faculties located in peripheral districts. Even today, certain medical faculties struggle to gain SLMC accreditation owing to a dearth of staff in their professorial units. There is no doubt that the more lucrative fee-levying medical schools will prey on the scarce resources of state medical faculties, making this situation worse.

Why is our generation who has benefitted from the Free Education policy so ready to give it up for future generations? Privatisation is not a solution to the many problems of and faced by the university system. Reforms are needed, but we need to arrive at these through a process of consultation. Rather than pushing through hasty, short-sighted educational reforms that appear to be driven by economic imperatives and narrow class interests, why not work on strengthening what we presently have?

It is no coincidence that KDU—an institution that can easily deploy the military—has been selected as the first experiment. Any resistance will be easily quelled unless there is a groundswell of public protest against these developments and other attempts to subvert Free Education in this country. While these decisions are being made by a President and Cabinet who have long lost whatever mandate they had, it is crucial that those aspiring to take over unambiguously express their views on this as a matter of urgency.

(Ramya Kumar is attached to the Department of Community and Family Medicine, University of Jaffna)

Kuppi is a politics and a pedagogy happening on the margins of the lecture hall that parodies, subverts and simultaneously reaffirms social hierarchies.



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The Ghost Stories of Edith Wharton

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Tales of Mystery and Suspense 16:

I have thus far looked only at novels, but in recent years I have also read several short story collections full of suspense and mystery. The first of these that I will explore is by someone not usually associated with such work. Edith Wharton was rather known for her incisive stories about American high society in the 19th century, on the lines of Henry James, though she was brilliant and less convoluted .

She was not someone I had read in childhood, but for some reason I have on my shelves several books by her, though I cannot now recollect from where they were all collected, and when. Over the years I read several of the novels I have, and enjoyed them, but for some reason I do not think I took down The Ghost Stories of Edith Wharton, a comparatively slim volume, that had been tucked away amongst my children’s books.

I could recollect none of the stories, except for the last two, the plots of which came back to me as I began reading them. One was called ‘All Souls’’ and was about a lady who lived by herself and found one night that all her servants had gone away, leaving her alone in the house. She had broken her ankle that day and been put to bed, with strict injunctions not to move, but when her bell was not answered she had staggered up, to find the electricity not working and no one at home. The voice she heard in the kitchen turned out to be from a radio.

When she awoke on what she thought the following morning, she was told she had imagined things and the servants were all back in place, and it was only the same morning. I had remembered by then that the probable explanation was that the servants had all gone to celebrate a witches’ sabbath, for it was All Souls’ Day when the dead walk. What I had forgotten was that before she fell she had seen a woman walking up to the house, and when a year later she saw the woman again, she fled, to stay with her cousin, who narrates the story. She never went back to the house.

The last story in the book is more straightforward, about a young man who goes to stay with an explorer he had met, who has set up house in the desert. But his host is not there when Medford arrives, and he is looked after by his manservant Gosling, who said Almondham was due back any day. But he did not arrive, and meanwhile there was less and less water to drink, for Medford refused wine and there was no Perrier.

Meanwhile his bath water smells, and I then remembered that in fact Gosling had killed his master, though perhaps not intentionally, and put him in the well. The reason was that he had not been allowed any leave and, just when he thought Almondham would relent, he said he was expecting a visitor and Gosling would have to stay on.

But while this is no great mystery, Edith Wharton creates suspense by making Medford worry about whether Gosling is correct in telling him not to trust the Arab servants, who were likely to kill him if he went off alone with them. And though it is more and more obvious that Gosling has not told him the truth, Medford is sure of nothing, until he suddenly finds Gosling about to push him into the stinking well, though he then backs off.

These two stories, which I remembered, perhaps because they had been anthologized elsewhere, were the most compelling, though I did find almost all the others also quite readable. And almost all held one’s interest, with the suspense being maintained until the end – and beyond it sometimes since the stories were sometimes open ended.

Amongst the most gripping was the story of a man who decided to visit the sister, who lived alone in Brittany, of an old friend. But when he got to a darkened house, he suddenly remembered that he had been told the woman had died. So he is quite convinced, when an old woman lets him in, and he is confronted by a shadowy figure on the stairs, that this is a ghost.

She begs him to stay, for she says she has felt appallingly lonely since she died, but he finally breaks away and flees. But when he tells the sister this, and says he is sorry he had not visited the grave, for she had wanted to be buried in her garden, he is told that she had not died, but only had a cataleptic fit, from which she had recovered.

Several other stories deal with adultery, or affection for a man, on the part of a woman treated badly by her husband. These stories, it is suggested, reflect Wharton’s own situation, for the man she married was serially unfaithful and not at all sympathetic, and they parted company. But women were expected to uphold rigid standards of behaviour, and many of Wharton’s heroines suffer accordingly.

The most dramatic of these involves a woman who meets her lover in a crypt, which her husband walls up, with a statue of her he has commissioned, the face of which breaks up to indicate the grief that overcame her. I have read similar outcomes in stories by Balzac and also Nirmali Hettiarachchi, adapted by the latter, but only here does stone change shape to express the grief that led to the deaths of all the women.

In another story a husband strangles a dog a woman lavished love on since she was alone, with a necklace he had given her and which she passed to an admirer, a necklace the husband had somehow got back. He then strangled all other dogs she paid attention to, but one night when she went down, the man who loved her having come back, to warn him that her husband was home, she heard him being attacked at the top of the stairs by the ghosts of all the dogs. And since dog bites were seen on the dead body, she was acquitted of the charge of murder which had been brought against her.

There are tales too of possession by dead women, one ending in an exorcism, the other with the husband vanishing, after getting letters from his dead wife, leaving his new wife and her mother dimly understanding what has happened. All these denouements are, if not as dramatic as in the last two stories, memorable, which is why I have little doubt this is the first time I read these other stories. And they serve to emphasize the talent of a remarkable woman, who made a life for herself away from the conventions of American society.

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To skillfully fall from the clouds…

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A memoir by Thamasha Abeynaike

Glancing at the phone for a photo before the start of the first charter flight of the day, I noticed the time was 11:11. It seemed like a nod from the universe that this was bound to be a memorable day — and the 27th of December 2021 didn’t disappoint.

Capt. Gihan Fernando (Capt. GAF) greeted us at the hangar and after a reminder to me, as an observer on the flight, to ‘Take lots of photos!’, we waved him goodbye.

After a flawless sector from Ratmalana to beautiful Sigiriya, PIC Capt. Dinindu Ruwanpathiranage (Capt. Dinny) taxiied onto the apron and we awaited the arrival of our passengers for the next sector : Sigiriya to Koggala.

To say we were blessed with the most relaxed and understanding couple as passengers for this sector would be an understatement.

Wassim and Marya, who are now an indescribable part of our aviation lives, shared their plans of a beautiful vacation on the coast of Weligama.

Landing Site — Circled in Red, Attempted Runway — On Bottom Left of picture

Personally, I was excited for my favourite approach in Sri Lanka — the approach into Koggala Airport — bordered on one end by the beach, and the other by the Koggala Lake.

Our take off from Sigiriya was at sharp 13:00h and our lives were shaken within the next 52 mins.

While overflying Kurunegala, and following a descent down to 5000ft MSL, the engine of our trusted 4R-GAF Cessna 172 aircraft started to run rough. Following troubleshoots and after our trained procedures, Capt. Dinny diverted to Katunayake International Airport.

The Italian phrase “Cadere dalle nuvole” (direct translation : ‘to fall from the clouds’) — means “When you’re forced to face the reality.”

We are trained in Forced Emergency Landing Procedures throughout our flying careers countless times. I, myself, have chatted to my friends over numerous dinners about aerodynamics and emergency procedures. However, when the actual engine of your aircraft is giving up on you, there is no definite prediction of descent rate and glide range.

At Nawaloka Hospital Colombo : Photo by Channa

Sigiriya Airport Apron : Photo by Wassim

We ran through the emergency procedures many times with one of our ever supportive passengers, Wassim, mentioning, ‘We will not disturb you. You guys get us down safely.’ No better words could have been spoken and a confident voice echoed in my head ‘We’re all going to be safe’.

While perfectly lined up with a cleared runway at Katunayake Airport and with Capt. Dinny talking to and working with a misfiring engine, the engine of our C172 finally completely shut down at 200ft.

This is a testament to the indefinable skill of Capt. Dinny — to make a split second decision to abandon the approach and turn to a paddy field on his right, upon which we touched down beautifully at an impressive speed of 55knots at 13:52h.

Unfortunately, while slowing down in the mud, the aircraft collided with a concrete road which was slightly raised from the field level.

Zoom image will be displayed

I am forever grateful for this sequence of events, as Capt. Dinny’s skill and the thought of keeping the nose raised throughout the landing roll, saved us from being crushed by the instrument panel collapsing onto us.

Six months later, we have

physically recovered.

After listening to the stories of hearing this news and rushing to our side — from our families, friends, students to the aviation community — I can only sum it all up to one word : Grateful.This redirection was a blessed awakening to the true value of life and what potential a great training, instinct and a calm mindset hold in this beautiful field of aviation.

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Complexities in global politics deepen as economic pressures intensify

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UK Prime Minister Andy Burnham meets Ukrainian President Volodymyr Zelensky in Kyiv. (BBC)

The present offer by the UK to strengthen Ukraine’s defense capabilities in the missile technology field in particular comes as ‘a stitch in time’ and the initiative is also likely to be appreciated considerably by democratic opinion world wide for the possible morale-boosting effect it would have on Ukraine. Besides continuous arms support, the conviction that the world’s frontline democracies are behind it would prove a huge plus in Ukraine’s eyes in its grinding fightback against the Russian invasion.

While continued US support for Ukraine could not be considered ‘a given’ any more, British Prime Minister Andy Burnham’s words during a recent visit to Kyiv that the UK would stand by Ukraine ‘for as long as it takes’ is the kind of assurance that Ukraine needs at present. For, the conflict in Ukraine is essentially a war of liberation conducted by the latter against an invader and deeply at issue here is the upholding of International Law and its foundational concepts, such as national sovereignty and a nation’s right to political self-determination. The world of democracy is of the firm view that the latter ideals cannot be compromised, come what may.

The UK has its work cut out in this connection. It would find it difficult to convince the Trump administration that it should staunchly stand by Ukraine but it could campaign vigorously with the rest of the West and the EU fold in particular to unflaggingly support the embattled and over-run country.

Ukraine has shown an impressive adeptness in using drone technology in particular against her enemy and has even manufactured her own hardware in this respect but using the relevant blueprints handed over by the UK for the manufacture of more sophisticated cruise missiles, for instance, may prove financially difficult, going forward. It is left to be seen whether the UK and the rest of the West who are with Ukraine will continue to be with her, considering their own rising financial constraints.

The latter impediments could only multiply in the future. Oil, gas and energy prices are on the rise and the latter costs are glaringly reflected in kitchens and meal tables the world over. As we go along consumer discontent would steadily intensify and governments, East and West, would need to figure out with considerable rigour and foresight how such disaffection could be ably managed. Failing which, in most democratic societies, the chances are that publics would be out on the streets demanding that their grievances be redressed forthwith.

These rising concerns are reflected in a recent move by some EU governments to consider imposing what is described as ‘a windfall tax’ on the profits specified major oil companies operating within their shores have made in the wake of the US-Israel war on Iran. The rationale apparently is to use such tax earnings to cushion the rising cost of living of their publics and bolster the respective countries’ social expenditure.

In a recent letter to the president of the EU Council the EU governments referred to said, among other things, while drawing attention to the ‘discontent that is growing over the rising cost of living’: ‘A common approach’ is needed that ‘ensures those who profit from the crisis contribute their share to reducing the burden on the general population.’ Meanwhile, Oxfam with reference to the above development is on record as calling for a ‘permanent windfall tax of at least 50% on profits exceeding a 10% return on investment.’

Such are the rising economic pressures on the majority of Western governments. The question to be posed is how consistent they would be in their assistance to Ukraine if they decide consensually to stand by her. The soaring cost of living in the West compels the conclusion that there could be no guarantee that Western assistance to Ukraine, particularly in the defense and security fields, would be of a longstanding kind.

Of particular concern would be the fact that the weapons systems on offer from the UK to Ukraine could be increasingly costly to manufacture going forward. Besides they would need to be manufactured and put into action without delay.

However, these considerations should in no way deflect Ukraine’s supporters from the principled policy stance of defending her to the extent possible. Because at issue is the defense of International Law and the democratic system of government from their enemies; fascism and authoritarian rule.

While during World Wars 1 and 2 the US was with the major democracies of the West, this time around with regard to Ukraine, the US has chosen to be at cross-purposes with them. For instance, in relation to tariff matters and defense expenditure, in the NATO context, the US is pursuing a hard line which puts it at polar opposites with the West. Thus it is no longer possible to talk unreservedly of a ‘Western democratic alliance’. Put plainly, the cause of democratic development has been weakened.

A measure of relief for the supporters of Ukraine in the West could come by way of the upcoming mid-term polls in the US. If the Democratic Party fares well in them the pressure would be on the Trump administration to defer to opposition opinion at home, accommodate the best interests of Ukraine in its West European policy and perhaps even work towards a diplomatic solution to the Ukraine crisis in cooperation with Russia. Accordingly, the Democratic Party would need to put the Trump administration on the defensive, so to speak.

Until such time Ukraine’s Western supporters have no choice but to remain committed to it, ensure its steadfast defense against the invasion and work judiciously towards keeping the economic pressures at home in check.

Interestingly, at the present juncture in international politics the US could be said to be more weak than strong. For example, it has to some extent been militarily humbled by Iran; so much so it is resorting to economic means to keep Iran in check.

In keeping with this strategy, the US has launched ‘a new big wave of anti-Iran economic sanctions’ at the time of writing, aimed at cutting Iran away from all its major income sources. Some of these relate to digital assets, technology, gold, aviation and shipping. The hoped for result is the complete severance of Iran from the US dollar system.

However, while the UK and EU have no choice but to adhere to their policy of backing Ukraine, going forward they would need to dialogue more closely with the US and ensure that it cooperates with them on outstanding questions, such as Ukraine and the strengthening of democracy. The well being of the world is served when the latter aim is pursued.

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