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Medical education at crossroads

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By Saman Gunatilake

MBBS, MD, FRCP, FCCP, Hon FRACP
Emeritus Professor of Medicine, University of Sri Jayewardenepura
Consultant Neurologist

One of the most quoted phrases of Karl Marx, the German philosopher and political theorist, popularly known as the ‘Father of Communism’, is “History repeats itself, first as a tragedy, second as a farce”. This quote has made its way to common usage through the years, especially the initial part of ‘History repeats itself’. Marx’s words seem to be a good fit for many occasions and the current attempts to restart private medical schools is one such situation. Whether Sri Lanka today is ready to venture into private medical education is a highly debatable issue at present and for a start it would be worthwhile to look back at the past.

History of Private medical schools

North Colombo Medical College (NCMC) was the first privately funded medical school in Sri Lanka. It started in 1980. Since its inception the NCMC came under criticism and opposition of many socialist elements in the island, and especially the state university student bodies. Their slogan was stop privatising medical education. These protests reached a peak in 1989 and university and medical faculty education was disrupted badly with student strikes and protests being a regular scenery. Soon after, the NCMC was nationalised with the government sending the army to occupy the buildings at Ragama stating security reasons. Its board was replaced by a Competent Authority, Prof. Carlo Fonseka. He continued as the first Dean when the NCMC was transferred to the University of Kelaniya as its Faculty of Medicine in 1991.

History repeated in 2008 and, as Marx said, this ended up in tragedy. The South Asian Institute of Technology and Medicine was established in 2008 by Dr. Neville Fernando with the aim to provide tertiary qualifications in medicine, engineering, and information technology, management and finance, and information communication technology and media. The institute was initially affiliated with the Nizhny Novgorod State Medical Academy (Russia), the Asian Institute of Technology (Thailand) and Buckinghamshire New University (England), awarding degrees through those respective institutes. In 2011 SAITM applied for recognition from the University Grants Commission (UGC) as a degree awarding institution, with the ability to award its own degrees. The UGC, in 2013, granted SAITM a degree awarding status despite protests from the Inter-University Students’ Federation (IUSF) and the Government Medical Officers’ Association (GMOA). These protests continued for months and student education came to a standstill, students not attending lectures and exams. MBBS courses dragged on and exams were delayed by over a year and as a result even the running of hospitals were affected. GMOA strikes disrupted patient care in hospitals countrywide. Even the parents of state medical school students formed a body to fight the issue after seeing the plight of their sons and daughters. Following a fast unto death campaign performed by the parents of State Medical Students, on 8th Nov 2017, the Government of Sri Lanka, decided to abolish SAITM, suspend the new enrollments immediately. Students who were doing the medicine course in SAITM and their parents too were in a very dire situation. Their course too dragged on and most had to spend up to 10 years before they qualified by joining overseas universities and the Kotelawala defense university medical faculty. The staff who were teaching in the SAITM were left to their own means. So, wasn’t this a tragedy in the real sense? If this is repeated it will be a farce in Marx’s words. Farce is defined by some as foolish show, mockery, a ridiculous sham. It seems the government probably misinformed by and together with a few retired academics are planning to repeat history. To understand why I say so, we need to have an in-depth knowledge of what the medical course entails.

Current status of medical education

MBBS courses in our medical faculties are very similar and run on similar curricula approved and monitored by the University Grants Commission and the Sri Lanka Medical Council. MBBS course is quite different from most other courses as it deals with ill living human beings. Major difference which non-medics are ignorant is that of the clinical training. More than 50% of the course involves training in hospitals in the last three years out of the total five years. Government has taken a decision to increase the numbers taken for medical courses and also to start two fee levying privately run medical schools. No one would be against this as a principle. Country needs more doctors and no question about it, also in the last 12 months many young and specialized doctors have left the country making some hospital sections even to close down.

First let’s consider the training in state medical schools and why new admissions cannot be increased freely. Clinical training in the last 3 years involve working in hospitals in all days of the week, some Sundays and some nights. From the days I was a medical student and till recently a batch of students would have about 150 students. They are divided into groups of about 12-15 in each group and are allocated to each ward to work under the supervision of a hospital consultant. If the group had 150 there would be about 12 groups. Training would be for a period of 2 months in major specialties like Medicine, Surgery, Paediatrics and Obstetrics and for 2 weeks in others like Cardiology, Neurology, ENT, Neurosurgery, Orthopaedics etc. A group is limited to 12 to 15 because that is about the maximum a hospital ward could accommodate and also suitable for bedside teaching. A ward in a state hospital generally have about 40 to 60 beds and so a student will be given to be in charge of 3 to 5 patients at a given time to study and discuss with senior doctors in the ward till those patients are discharged and then a new patient will be allocated. This is a very dynamic process that changes daily. If the student numbers are increased this system will fail as the hospital has only a limited number of wards, patients and teachers. Prior to increasing student numbers hospital facilities have to be increased to suit the increase. This involves long term plans like increasing available number of hospital wards, beds and trained teachers. If the numbers were increased without paying attention to availability of adequate infrastructure standards will go down. Our MBBS graduates have a good standing internationally and the degree is recognized by the UK and Australian medical councils.

Colombo, Peradeniya, Galle, Jaffna, Jayawardenepura, Rajarata and Eastern are well established medical faculties. Of them Rajarata and Eastern are still understaffed and don’t have professors in most departments. Recently Rajarata had to close down the paediatric unit due to lack of specialist consultants. Sabaragamuwa (Ratnapura), Wayamba (Kuliyapitiya), Uva (Badulla) and Moratuwa are new faculties started recently and have enrolled students. Sabaragamuwa students are ready to start their final year but the final year clinical attachments haven’t been sorted yet and the final year departments have no staff to teach and they have no hospital wards under them. They are struggling to find qualified staff and have no proper buildings to house their laboratories, and lecture halls. Departments have only one or two permanent members. Universities need to attract young and bright lecturers but the opposite is the truth, there is no suitable background for them to join these faculties and many are leaving the country for overseas jobs.

These new faculties are facing the issue of finding suitable hospitals for student training. Most hospitals that are suitable for training are already being used by established state faculties. Most days of the week students spend the mornings in the hospital and attend lectures and tutorials in the faculty and return to hospital for seeing patients. For this the hospital and faculty have to be close to each other. The new faculties are in a crisis situation finding hospitals for training of their students. These shortages will escalate student unrest. Hostel facilities are another important issue as students in a faculty are from all parts of the island. There have been requests from authorities to increase the intake of students to Colombo and Galle and from what I know to increase the intake to 300 from the current 150-200. This is an impossible task. Lectures can be done on line, but in medicine, surgery and other hospital specialties the most effective modes of training are using small group discussions and bedside teaching. Students need to spend time in operating theatres watching operations, but the number that can be allowed in to an operating theatre is limited due to risks of infection. Such ad hoc increse cannot be done without compromising on the training and overcrowding of hospital wards. Patient welfare is also an important area to consider.

When too many students are in a ward, patients will be disturbed by students trying to examine them and this would cause negative responses from patients and their relatives. With all these drawbacks and the apparent collision course the state medical faculties are heading, new private medical schools are to be established with government approval. Where would this lead us to?

New Private Medical faculties

In Sri Lanka, becoming a doctor is still the number one choice for most students. Therefore, there is a bigger demand than that can be catered for. So, the parents who can afford seek entry into overseas medical schools pay exorbitant fees. They are studying medicine in China, Russia, eastern Europe, UK, Malaysia, Australia and India, to name a few. Some argue that the country can save foreign exchange if these students can be educated locally. Many would wish for private medical education in Sri Lanka and that is a very reasonable one. But are we ready for that as a country, and is this the opportune time? From what I have said before it is apparent that starting state medical faculties in the recent past had been done without proper plans and foresight. Where are we going to find clinical teachers and hospitals to cater private medical schools? Clinical teachers have to be selected from high achievers. They should have adequate experience in teaching, proper postgraduate qualifications and outstanding academic records. Parents would not pay fees if the faculty is not up to international standards. Obtaining international recognition too would be a difficult task. This would be a problem that would be faced by even the new state medical faculties. If the terms are attractive state medical faculty teachers may join the private medical schools. That would make the situation in state faculties much worse. When there are no suitable hospitals for training of state medical students where would you train private students? This would result in student protests and student rivalry and even clashes. Result: history repeats, as a farce or tragedy again? There are some private hospitals mainly in Colombo suitable for student training but may not be adequate. Hospitals have to be in close vicinity to where other teachings are done, or else the hospital should provide facilities for lectures and other non-clinical work. The urgent need is to look after the already established medical faculties. Some may even run the risk of losing their local and foreign medical council recognition. From what I know at present the situation in some are terrible and need urgent attention. Starting a private medical school or two will not help to earn dollars to save our bankrupt economy. Time to venture into Private medical schools would be when we have recovered economically and our state faculties are doing well. The question is how long will that be?



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Ranking public services with AI — A roadmap to reviving institutions like SriLankan Airlines

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Efficacy measures an organisation’s capacity to achieve its mission and intended outcomes under planned or optimal conditions. It differs from efficiency, which focuses on achieving objectives with minimal resources, and effectiveness, which evaluates results in real-world conditions. Today, modern AI tools, using publicly available data, enable objective assessment of the efficacy of Sri Lanka’s government institutions.

Among key public bodies, the Supreme Court of Sri Lanka emerges as the most efficacious, outperforming the Department of Inland Revenue, Sri Lanka Customs, the Election Commission, and Parliament. In the financial and regulatory sector, the Central Bank of Sri Lanka (CBSL) ranks highest, ahead of the Securities and Exchange Commission, the Public Utilities Commission, the Telecommunications Regulatory Commission, the Insurance Regulatory Commission, and the Sri Lanka Standards Institution.

Among state-owned enterprises, the Sri Lanka Ports Authority (SLPA) leads in efficacy, followed by Bank of Ceylon and People’s Bank. Other institutions assessed included the State Pharmaceuticals Corporation, the National Water Supply and Drainage Board, the Ceylon Electricity Board, the Ceylon Petroleum Corporation, and the Sri Lanka Transport Board. At the lower end of the spectrum were Lanka Sathosa and Sri Lankan Airlines, highlighting a critical challenge for the national economy.

Sri Lankan Airlines, consistently ranked at the bottom, has long been a financial drain. Despite successive governments’ reform attempts, sustainable solutions remain elusive.

Globally, the most profitable airlines operate as highly integrated, technology-enabled ecosystems rather than as fragmented departments. Operations, finance, fleet management, route planning, engineering, marketing, and customer service are closely coordinated, sharing real-time data to maximise efficiency, safety, and profitability.

The challenge for Sri Lankan Airlines is structural. Its operations are fragmented, overly hierarchical, and poorly aligned. Simply replacing the CEO or senior leadership will not address these deep-seated weaknesses. What the airline needs is a cohesive, integrated organisational ecosystem that leverages technology for cross-functional planning and real-time decision-making.

The government must urgently consider restructuring Sri Lankan Airlines to encourage:

=Joint planning across operational divisions

=Data-driven, evidence-based decision-making

=Continuous cross-functional consultation

=Collaborative strategic decisions on route rationalisation, fleet renewal, partnerships, and cost management, rather than exclusive top-down mandates

Sustainable reform requires systemic change. Without modernised organisational structures, stronger accountability, and aligned incentives across divisions, financial recovery will remain out of reach. An integrated, performance-oriented model offers the most realistic path to operational efficiency and long-term viability.

Reforming loss-making institutions like Sri Lankan Airlines is not merely a matter of leadership change — it is a structural overhaul essential to ensuring these entities contribute productively to the national economy rather than remain perpetual burdens.

By Chula Goonasekera – Citizen Analyst

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Why Pi Day?

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International Day of Mathematics falls tomorrow

The approximate value of Pi (π) is 3.14 in mathematics. Therefore, the day 14 March is celebrated as the Pi Day. In 2019, UNESCO proclaimed 14 March as the International Day of Mathematics.

Ancient Babylonians and Egyptians figured out that the circumference of a circle is slightly more than three times its diameter. But they could not come up with an exact value for this ratio although they knew that it is a constant. This constant was later named as π which is a letter in the Greek alphabet.

Archimedes

It was the Greek mathematician Archimedes (250 BC) who was able to find an upper bound and a lower bound for this constant. He drew a circle of diameter one unit and drew hexagons inside and outside the circle such that the sides of each hexagon touch the sides of the circle. In mathematics the circle passing through all vertices of a polygon is called a ‘circumcircle’ and the largest circle that fits inside a polygon tangent to all its sides is called an ‘incircle’. The total length of the smaller hexagon then becomes the lower bound of π and the length of the hexagon outside the circle is the upper bound. He realised that by increasing the number of sides of the polygon can make the bounds get closer to the value of Pi and increased the number of sides to 12,24,48 and 60. He argued that by increasing the number of sides will ultimately result in obtaining the original circle, thereby laying the foundation for the theory of limits. He ended up with the lower bound as 22/7 and the upper bound 223/71. He could not continue his research as his hometown Syracuse was invaded by Romans and was killed by one of the soldiers. His last words were ‘do not disturb my circles’, perhaps a reference to his continuing efforts to find the value of π to a greater accuracy.

Archimedes can be considered as the father of geometry. His contributions revolutionised geometry and his methods anticipated integral calculus. He invented the pulley and the hydraulic screw for drawing water from a well. He also discovered the law of hydrostatics. He formulated the law of levers which states that a smaller weight placed farther from a pivot can balance a much heavier weight closer to it. He famously said “Give me a lever long enough and a place to stand and I will move the earth”.

Mathematicians have found many expressions for π as a sum of infinite series that converge to its value. One such famous series is the Leibniz Series found in 1674 by the German mathematician Gottfried Leibniz, which is given below.

π = 4 ( 1 – 1/3 + 1/5 – 1/7 + 1/9 – ………….)

The Indian mathematical genius Ramanujan came up with a magnificent formula in 1910. The short form of the formula is as follows.

π = 9801/(1103 √8)

For practical applications an approximation is sufficient. Even NASA uses only the approximation 3.141592653589793 for its interplanetary navigation calculations.

It is not just an interesting and curious number. It is used for calculations in navigation, encryption, space exploration, video game development and even in medicine. As π is fundamental to spherical geometry, it is at the heart of positioning systems in GPS navigations. It also contributes significantly to cybersecurity. As it is an irrational number it is an excellent foundation for generating randomness required in encryption and securing communications. In the medical field, it helps to calculate blood flow rates and pressure differentials. In diagnostic tools such as CT scans and MRI, pi is an important component in mathematical algorithms and signal processing techniques.

This elegant, never-ending number demonstrates how mathematics transforms into practical applications that shape our world. The possibilities of what it can do are infinite as the number itself. It has become a symbol of beauty and complexity in mathematics. “It matters little who first arrives at an idea, rather what is significant is how far that idea can go.” said Sophie Germain.

Mathematics fans are intrigued by this irrational number and attempt to calculate it as far as they can. In March 2022, Emma Haruka Iwao of Japan calculated it to 100 trillion decimal places in Google Cloud. It had taken 157 days. The Guinness World Record for reciting the number from memory is held by Rajveer Meena of India for 70000 decimal places over 10 hours.

Happy Pi Day!

The author is a senior examiner of the International Baccalaureate in the UK and an educational consultant at the Overseas School of Colombo.

by R N A de Silva

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Sheer rise of Realpolitik making the world see the brink

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A combined US-Israel attack on Iran.(BBC)

The recent humanly costly torpedoing of an Iranian naval vessel in Sri Lanka’s Exclusive Economic Zone by a US submarine has raised a number of issues of great importance to international political discourse and law that call for elucidation. It is best that enlightened commentary is brought to bear in such discussions because at present misleading and uninformed speculation on questions arising from the incident are being aired by particularly jingoistic politicians of Sri Lanka’s South which could prove deleterious.

As matters stand, there seems to be no credible evidence that the Indian state was aware of the impending torpedoing of the Iranian vessel but these acerbic-tongued politicians of Sri Lanka’s South would have the local public believe that the tragedy was triggered with India’s connivance. Likewise, India is accused of ‘embroiling’ Sri Lanka in the incident on account of seemingly having prior knowledge of it and not warning Sri Lanka about the impending disaster.

It is plain that a process is once again afoot to raise anti-India hysteria in Sri Lanka. An obligation is cast on the Sri Lankan government to ensure that incendiary speculation of the above kind is defeated and India-Sri Lanka relations are prevented from being in any way harmed. Proactive measures are needed by the Sri Lankan government and well meaning quarters to ensure that public discourse in such matters have a factual and rational basis. ‘Knowledge gaps’ could prove hazardous.

Meanwhile, there could be no doubt that Sri Lanka’s sovereignty was violated by the US because the sinking of the Iranian vessel took place in Sri Lanka’s Exclusive Economic Zone. While there is no international decrying of the incident, and this is to be regretted, Sri Lanka’s helplessness and small player status would enable the US to ‘get away with it’.

Could anything be done by the international community to hold the US to account over the act of lawlessness in question? None is the answer at present. This is because in the current ‘Global Disorder’ major powers could commit the gravest international irregularities with impunity. As the threadbare cliché declares, ‘Might is Right’….. or so it seems.

Unfortunately, the UN could only merely verbally denounce any violations of International Law by the world’s foremost powers. It cannot use countervailing force against violators of the law, for example, on account of the divided nature of the UN Security Council, whose permanent members have shown incapability of seeing eye-to-eye on grave matters relating to International Law and order over the decades.

The foregoing considerations could force the conclusion on uncritical sections that Political Realism or Realpolitik has won out in the end. A basic premise of the school of thought known as Political Realism is that power or force wielded by states and international actors determine the shape, direction and substance of international relations. This school stands in marked contrast to political idealists who essentially proclaim that moral norms and values determine the nature of local and international politics.

While, British political scientist Thomas Hobbes, for instance, was a proponent of Political Realism, political idealism has its roots in the teachings of Socrates, Plato and latterly Friedrich Hegel of Germany, to name just few such notables.

On the face of it, therefore, there is no getting way from the conclusion that coercive force is the deciding factor in international politics. If this were not so, US President Donald Trump in collaboration with Israeli Rightist Premier Benjamin Natanyahu could not have wielded the ‘big stick’, so to speak, on Iran, killed its Supreme Head of State, terrorized the Iranian public and gone ‘scot-free’. That is, currently, the US’ impunity seems to be limitless.

Moreover, the evidence is that the Western bloc is reuniting in the face of Iran’s threats to stymie the flow of oil from West Asia to the rest of the world. The recent G7 summit witnessed a coming together of the foremost powers of the global North to ensure that the West does not suffer grave negative consequences from any future blocking of western oil supplies.

Meanwhile, Israel is having a ‘free run’ of the Middle East, so to speak, picking out perceived adversarial powers, such as Lebanon, and militarily neutralizing them; once again with impunity. On the other hand, Iran has been bringing under assault, with no questions asked, Gulf states that are seen as allying with the US and Israel. West Asia is facing a compounded crisis and International Law seems to be helplessly silent.

Wittingly or unwittingly, matters at the heart of International Law and peace are being obfuscated by some pro-Trump administration commentators meanwhile. For example, retired US Navy Captain Brent Sadler has cited Article 51 of the UN Charter, which provides for the right to self or collective self-defence of UN member states in the face of armed attacks, as justifying the US sinking of the Iranian vessel (See page 2 of The Island of March 10, 2026). But the Article makes it clear that such measures could be resorted to by UN members only ‘ if an armed attack occurs’ against them and under no other circumstances. But no such thing happened in the incident in question and the US acted under a sheer threat perception.

Clearly, the US has violated the Article through its action and has once again demonstrated its tendency to arbitrarily use military might. The general drift of Sadler’s thinking is that in the face of pressing national priorities, obligations of a state under International Law could be side-stepped. This is a sure recipe for international anarchy because in such a policy environment states could pursue their national interests, irrespective of their merits, disregarding in the process their obligations towards the international community.

Moreover, Article 51 repeatedly reiterates the authority of the UN Security Council and the obligation of those states that act in self-defence to report to the Council and be guided by it. Sadler, therefore, could be said to have cited the Article very selectively, whereas, right along member states’ commitments to the UNSC are stressed.

However, it is beyond doubt that international anarchy has strengthened its grip over the world. While the US set destabilizing precedents after the crumbling of the Cold War that paved the way for the current anarchic situation, Russia further aggravated these degenerative trends through its invasion of Ukraine. Stepping back from anarchy has thus emerged as the prime challenge for the world community.

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