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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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Polarizing rhetoric greets America on its epochal anniversary

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President Donald Trump addresses the public on the occasion of the US celebrating the 250th anniversary of the US Declaration of Independence from Britain.(BBC)

Democratic and progressive opinion in the US and the world over would likely have been further jolted by the divisive rhetoric blared forth by US President Donald Trump on no less an occasion than the 250th anniversary of the US Declaration of Independence from Britain. The world has been placed on notice that what it would be having in the main is aggravated polarization on multiple fronts during what’s left of the Trump tenure.

If the world was expecting positive moves by the Trump administration to bridge divisions, heal rifts and usher in a more harmonious international political order, this is very unlikely to be. Instead, in all probability we would be left with a far more ‘dangerous place to live in’.

Some of the more thought-provoking recent ‘takes’ from President Trump are : ‘A generation after we fought and won the cold war against the menace of communism, there is now a resurgence of the communist menace in our land, including from newcomers to our country who embrace ideas totally opposed to our way of life and our great success.’ ‘We will send them (immigrants) quickly away, and we will continue to build our country bigger and better than ever before.’ ‘We are going to give our country its identity back.’ ‘You can be loyal to Karl Marx or you can be loyal to America. You can be a communist or you can be a patriot. You cannot be both.’

Accordingly, what the world would have in increasing measure going forward are stepped-up attempts to consolidate a white supremacist administration in the US accompanied by a suppression of ethnic, religious and cultural minorities at home along with renewed attempts to spread and consolidate US hegemonism world wide.

The latter project would mainly translate into US military interventions abroad of the Venezuelan type and a persistence if not a resurgence of identity based conflicts globally. Violent reactions internationally to what are seen as attempts by the US to bring recalcitrant sections in particularly the South under white supremacist control will provide the basis for the steadfast presence and spiking of identity politics globally.

Moreover, the path has been paved for stepped-up ethnic, religious and cultural disharmony within the US. A united state is far from possible, given this backdrop. Put simply, it would be a question of steeper political polarization at home and abroad.

The persistent, widespread support for the hard line Islamic regime in Iran locally and globally should serve as an eye-opener for the political decision-makers of the US. Huge crowds at the funerals of Iran’s political leaders could very well be state-orchestrated but they are a pointer to the fact that political Islam is far from on the decline. To the extent to which this is so, the phenomenon could be a hurdle in the path of a stridently expansionist US.

Looking back, it was the consolidation of the Islamic regime in Iran in the late seventies of the last century that, besides proving a major challenge to the unfettered global power expansion of the US and its Western allies, provided the motive force as it were for the proliferation of Islam-based identity politics in particularly the South. This continues to be so.

Going forward, the US would need to figure out how best it could manage the persistent presence of Islamic fundamentalism world wide, and for that matter other forms of identity politics, without drastically losing its global power and influence.

The recent successful challenge by Iran to the US’ efforts to exercise its diktat in West Asia should prove an ‘eye-opener’. In these confrontations both sides were bloodied but Iran proved that it could successfully take on the US militarily. The inference for the US ought to be that projecting its military might in the Middle East in a no-holds-barred fashion would not prove easy.

Arising from the foregoing a foremost policy challenge for the US would be to curb Iranian military power while avoiding another major military confrontation with the Islamic state that would cost the US and the world dearly in particularly economic and material terms. The US would have no choice but to persist with the often flagging West Asian peace effort and to render it fully workable.

Ukraine presents the US with another formidable challenge. As is known, Ukraine is proving no easy ‘push-over’ for Russia, but it is badly in need of more sophisticated Western arms, particularly effective air defense systems, to fully neutralize the Russian invasion. What would the US choose to do; go to Ukraine’s assistance fully or opt not to ruffle and antagonize the Putin regime, with which it is on some cordial terms?

A negotiated solution is best in Ukraine and the Trump administration would do well not to lose sight of this ideal but Russia too should see the need for a diplomatic solution if it is to salvage itself from its military stalemate in Ukraine. The US needs to try being a peace mediator in the latter theatre but if the Russian political leadership fails to opt for peace the US would have no choice but to join the rest of NATO and Europe in continuing to arm Ukraine.

The US would need to take the latter course if the ‘world’s mightiest democracy’ is to remain committed to its founding ideals. If President Trump fails to meet this challenge he would prove that he is nothing more than an ‘empty rhetorician’.

However, it should not come as a surprise to the world if Trump chooses not to strongly back the rest of the West on Ukraine. Domestic and foreign policy are closely intertwined. Since the Trump administration is committed to building a white supremacist state at home, democratic development worldwide has been of the least importance to it.

The Trump administration’s strong affinities to white jingoism would increasingly compel it to opt for a policy of international isolationism. As a result Ukraine could prove unimportant for the US going forward.

Consequently, US-Western Europe friction in particular is only likely to intensify in the days ahead. Coupled with the contentious issues growing out of the persistence of identity politics, the Trump administration’s far-sightedness in managing foreign policy issues would be tested to the fullest. Whether the world would have comparative peace or continued blood-letting would depend crucially on such judiciousness.

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Beyond concrete: Sunela Jayewardene urges Sri Lanka to rediscover an ancient wisdom for a planet in peril

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Sunela / Rishan / Spencer

It was more than a lecture on architecture. It was a challenge to rethink civilisation itself.

Standing before a packed audience at Dilmah by Genesis in Maligawatte, internationally acclaimed environmental architect, author and conservationist Sunela Jayewardene delivered a keynote that transcended blueprints, buildings and urban planning.

Instead, she invited her listeners on an intellectual journey into Sri Lanka’s ancient past, arguing that the answers to some of the world’s gravest environmental crises may already exist within the island’s forgotten ecological wisdom.

Her address, titled “Beyond Concrete: Architecture for the Coexistence of Species,” was at once philosophical, historical and deeply practical. It questioned humanity’s obsession with dominating nature and called for a return to a design ethic rooted in respect, restraint and coexistence.

“The road is actually very simple,” Jayewardene said. “We have simply forgotten it.”

That observation became the defining thread of an afternoon that challenged conventional thinking about architecture and development.

According to Jayewardene, modern society has inherited a worldview shaped largely by colonial values that placed human needs above those of every other living organism.

“Our value system was turned on its head,” she observed. “We accepted a Western way of looking at nature without questioning it. Today we can clearly see the consequences. The world is in crisis. Species are in crisis. Our lifestyles are in crisis.”

She was careful not to romanticise the past, nor was she dismissive of modern science. Instead, she argued that Sri Lanka’s pre-colonial civilisation possessed a sophisticated environmental philosophy that modern planners and architects have largely ignored.

For Jayewardene, environmental architecture is not about fashionable sustainability slogans or cosmetic landscaping.

It begins with humility.

It begins by recognising that humans are only one species among millions sharing the same landscape.

“The built environment should not exist in opposition to nature,” she said. “It should become part of nature.”

One of the most captivating moments of her presentation came when she introduced her own research into the island’s ancient sacred geography.

Using digital mapping and satellite imagery, Jayewardene demonstrated the remarkable alignment of Sri Lanka’s four original Saman Devalayas, whose axes converge on Sri Pada, historically known as Samanthakuta.

The extraordinary precision of these alignments, she argued, raises profound questions about the scientific and surveying capabilities of ancient Sri Lankan civilisation.

“What kind of technology enabled them to achieve this?” she asked the audience.

Her purpose was not to offer speculative answers but to challenge deeply ingrained assumptions that ancient societies lacked scientific sophistication.

“We often underestimate what our ancestors knew,” she said. “Yet the evidence around us tells a very different story.”

That forgotten knowledge, she argued, extended well beyond engineering.

It shaped an entire philosophy of living with the landscape rather than imposing human will upon it.

Displaying photographs from archaeological sites including Ritigala, ancient monasteries and rock pavilions hidden within Sri Lanka’s forests, Jayewardene illustrated how builders carved steps around natural boulders, integrated structures into existing rock formations and preserved the contours of the land.

Modern construction, she suggested, would almost certainly have bulldozed those landscapes into submission.

“Our ancestors honoured the land,” she said. “They accepted the landscape instead of trying to conquer it.”

For Jayewardene, that principle remains the foundation of every project she undertakes.

She described environmental architecture as an exercise in listening rather than commanding.

Every site, she explained, possesses its own identity, ecological history and natural rhythm.

The responsibility of the architect is to understand that identity before attempting to intervene.

“The land tells you what it wants to become,” she said.

Throughout the presentation, one word repeatedly surfaced—context.

Without understanding context, she argued, architecture becomes little more than sculpture.

Good design cannot be copied indiscriminately from one country to another or even from one district to another.

Climate differs.

Rainfall differs.

Vegetation differs.

Wildlife differs.

Culture differs.

Even the stories associated with landscapes differ.

All of these, Jayewardene insisted, must shape architecture.

“When I speak about inhabitants, I don’t mean only human beings,” she explained.

“The birds, insects, reptiles, mammals, trees and every living organism already occupying that land must become part of the design equation.”

This broader understanding forms the basis of what she describes as non-human-centred design—an approach that rejects the notion that cities exist exclusively for people.

Instead, landscapes should provide refuge for biodiversity while simultaneously serving human communities.

It is an idea that resonates strongly at a time when rapid urbanisation continues to erode habitats across Sri Lanka.

Jayewardene also challenged prevailing attitudes towards development itself.

Too often, she argued, “development” has become synonymous with replacing natural systems by concrete infrastructure.

She questioned whether flattening hillsides, redirecting streams and clearing vegetation can genuinely be described as progress.

In her view, genuine development should first ask what ecological value already exists before deciding what should be built.

One of the simplest yet most profound examples she offered concerned water.

“I always say it is acceptable to interrupt water,” she remarked. “But never disrupt it.”

That distinction reflects an ecological understanding often absent from conventional engineering.

Natural drainage systems, she warned, perform countless functions that remain invisible until they are damaged.

Floods, soil erosion, biodiversity decline and even changes in local climate frequently follow.

“We disrupt far more than water,” she said. “We disrupt entire ecological relationships.”

Equally significant was her distinction between degraded brownfield sites and relatively untouched greenfield landscapes.

Brownfield sites require ecological restoration, rehabilitation and renewal.

Greenfield sites demand restraint.

Minimal intervention, she argued, is often the highest form of environmental design.

The keynote found an appropriate setting within Dilmah Conservation’s own efforts to restore degraded urban landscapes.

Earlier in the programme, Rishan Sampath of Dilmah Conservation outlined the organisation’s transformation of an abandoned industrial property in Moratuwa into a flourishing urban forest containing over 300 tree species and more than 1,000 individual plants.

Scientific studies conducted within the restored forest have already demonstrated improvements in air quality compared with adjoining urban roads, providing measurable evidence that biodiversity restoration can improve city life.

For Jayewardene, such initiatives represent far more than beautification projects.

They demonstrate that ecological restoration can become a guiding philosophy for future urban planning.

Her address ultimately became a call to rethink humanity’s place within nature.

Architecture, she argued, should no longer celebrate domination over landscapes.

It should celebrate coexistence.

Every building should strengthen biodiversity.

Every development should restore ecological balance.

Every designer should ask not merely how a project serves people, but how it serves life itself.

As the audience left the hall, they carried with them more than architectural ideas.

They carried a challenge

To question inherited assumptions.

To rediscover indigenous ecological wisdom.

And to recognise that Sri Lanka’s greatest contribution to global sustainability may not lie in importing new environmental models, but in rediscovering the timeless principles embedded within its own civilisation.

For Sunela Jayewardene, the future will not be secured by building more impressive skylines.

It will be secured when humanity learns once again to build gently, intelligently and respectfully—allowing architecture to become not an act of conquest, but an expression of coexistence.

By Ifham Nizam

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Colombia’s “back-to-back queen”

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Beyond modelling, Colombia’s Katherine Castaño, who captured the crown at the Top Model of the World 2026, in Egypt, is also a TV host, entrepreneur and social media influencer.

She’s based in Miami, Florida right now — a hub for fashion and influencer work — a city she calls home base, while representing Colombia on the world stage.

Her Miami base gives her access to fashion, entertainment, and business networks, while her title keeps Colombia front and centre in the global modelling conversation.

Off the runway, she says she enjoys singing, playing the piano, and tennis.

Katherine didn’t make the trip to Egypt as a newcomer. She’s built a strong international portfolio before winning the crown.

In fact, her résumé reads like a fashion passport: Colombia Moda, New York Fashion Week, Miami Swim Week, Miami Fashion Week, Nicaragua Diseña, IXEL Moda, and Mercedes-Benz San José.

On June 8, 2026, Katherine Castaño was crowned by outgoing winner Natalia Garizabal Vera, also of Colombia. That gave Colombia a historic back-to-back victory — the first time any country has done it in the competition’s history, and Colombia’s 4th win overall.

As Top Model of the World 2026, Katherine’s reign is centred on elevating her profile as a model, influencer, and entrepreneur.

She’s built a personal brand around beauty, ambition, style, and professionalism, with strong reach across fashion, social media, and business.

As titleholder, she’s now the face of the pageant’s international fashion platform, representing Colombia globally, while based out of Miami.

Ahead of the competition she was clear about the stakes: “This is bigger than me. This is for my country. This is for the story I’m here to write… And I’m not going quietly… we’re going for that back to back.”

As the reigning titleholder, Katherine Castaño’s role extends far beyond the sash. She’s using the platform to grow her brand as a model, influencer, and entrepreneur rooted in “beauty, ambition, style, and professionalism”.

She will also be doing runway shows, photoshoots, brand appearances, and fashion events.

Sri Lanka’s representative at this pageant was NetalieWithanage.

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