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Private medical schools: Next assault on Free Education?



A protest against SAITM

By Ramya Kumar

Interest-free loans of LKR 1.1 million are to be offered for students to follow degree programmes at private higher educational institutions. An amendment to the Universities Act has been proposed to establish a Quality Assurance Council under the University Grants Commission (UGC) to maintain the quality of academic programmes offered by state and non-state higher educational institutions.

According to the government, these policies are designed to increase access to higher education and standardize the quality of academic programmes. However, the relentless attacks on the student movement, arbitrary arrests of Inter-University Students’ Federation (IUSF) leaders and the media campaigns against free education signal a different agenda: privatisation. As the government sets the stage for a ‘radical’ revamping of higher education, this article looks at what might be in store for medical education.

Minimum standards

Private medical education is a sensitive topic in Sri Lanka, so much so that the government has kept mum about its plans. The foundation for the establishment of private medical schools has already been laid through the setting up of an Accreditation Unit under the Sri Lanka Medical Council (SLMC). The medical fraternity may oppose private medical schools of questionable standards, but does not, in principle, object to private medical education. Indeed, there is much complacency on this front since the gazetting of the Minimum Standards of Medical Education in 2018, after the SAITM debacle. Even the Government Medical Officers’ Association (GMOA), which opposed SAITM based on ‘quality’ concerns, now simply demands that they be consulted in matters pertaining to private medical education.

It is believed that the quality of MBBS degree programmes can be assured by the requirements set out in the Minimum Standards, for instance, minimum qualifications for student admission, staff requirements, hospital bed numbers, bed occupancy rates, etc. To be sure, the Minimum Standards do set much-needed ‘benchmarks’ to check the proliferation of low-quality private medical schools.

However, by considering state and non-state medical schools on an equal footing, neither the Minimum Standards nor accreditation processes give due consideration to the impact private medical schools will have on state medical faculties. In particular, they overlook equity and justice in access to medical education.

An unhealthy symbiosis

Take, for instance, the staff requirements laid out in the Minimum Standards. In terms of academic staff, the Standards specify that MBBS degree-awarding institutions should “conform to teacher-student ratios… not less than one teacher for every 14 medical students, taking into account the permanent academic staff and the extended faculty of specialists in affiliated teaching hospitals and other healthcare settings.” They include provisions for a balance between full-time and part-time academic staff, and ask that “all medically qualified staff engaged in patient care are registered with the designated body responsible for registration of medical professions in the relevant country” (Note: the Minimum Standards apply to overseas medical schools that produce MBBS graduates who intend to work in Sri Lanka).

In the event that private medical schools set foot in the country, it is unlikely that these institutions will be able to attract diaspora medical professionals who could renew their SLMC registration, given the economic situation in the country. Therefore, these institutions would need to rely on retired medical professionals or current teaching faculty at state medical faculties. As the Standards do not place limits on teaching hours, university teachers will be able to divide their time between public and private medical schools (akin to ‘dual practice’ by clinicians) or, if the benefits are appealing, a wholesale movement from state to private medical schools may occur.

If teaching faculty engage in ‘dual practice’ in state and private medical schools, there is no guarantee that their primary commitments will remain with state medical faculties. Given the required hospital beds and occupancy rates specified in the Minimum Standards, private medical schools may need to rely on public hospitals for clinical training. For this reason, they may be located adjacent to tertiary hospitals in peripheral districts that do not serve as clinical training centres for students of state medical faculties.

Winners and losers

Student intake to state universities, including medical faculties, has steeply risen in recent years (see table). Even so, the Colombo Medical Faculty has been able to maintain its student to permanent academic staff ratio at 7:1. Owing to its location, the Colombo Medical Faculty would be able to attract medical professionals to full-time teaching positions despite the higher salaries offered by the Ministry of Health.

However, the student to permanent academic staff ratio at the Jaffna Medical Faculty has risen over the years, climbing to 19:1 in 2021. The availability of vacant cadre positions at Ministry of Health institutions in and around Jaffna gives medical professionals no reason to resign from the Ministry to take up teaching positions that pay substantially less. (See table)

The requirement of 14:1 is fulfilled by state medical faculties in peripheral districts when temporary staff and extended faculty at teaching hospitals are considered. Yet, curriculum development, ‘quality assurance,’ student welfare and other time-consuming activities are undertaken primarily by permanent academic staff. If private medical schools are established in such districts, state medical faculties will need to compete not only with the Ministry of Health, but also with private medical schools that can offer much higher salaries, causing a dearth in teaching staff at state medical faculties.

Equity of access

The government will gloss over equity concerns by promising loans, voucher schemes and other carrots to study at private medical schools. Even as the state university system as a whole is seeing declines in state investment (see table), and even more so after the economic crisis, it is unclear how these loans will be financed. Accumulating student debt has shown to influence the career choices of medical students in other settings.

As the country struggles to retain medical professionals, it is unlikely that medical graduates burdened by student debt will serve in the public health sector under the present salary structure. It is even less likely that fee-levying international students, the government’s primary target for forex, will serve in Sri Lanka’s health sector. In other words, whether private medical schools will produce medical professionals to service the healthcare needs of ordinary citizens is uncertain.

The entry of private medical schools will change the demographic makeup of medical students by creating a two-tiered system of medical education. Given the emphasis on student resumes and ‘soft skills’, not to mention the hefty fees that will be levied, those who enter private medical schools will mostly represent the middle/upper-middle classes. According to UGC statistics, in 2020/2021, about 63% of enrollment in state medical faculties was through the district quote system. While the Colombo elite suggest that this is a form of reverse discrimination, such arguments overlook the tremendous disadvantages experienced by students from rural districts.

A closer look at the UGC’s admission statistics of 2020/2021 shows that the majority of students who entered medicine from the Vanni districts, Polonnaruwa, Anuradhapura, Moneragala and Nuwara Eliya, did so through the district quotas. With the entrenchment of private medical education, and weakening of state medical faculties, the opportunities for students from rural and plantation districts to access medical education will contract. It must be remembered that it is also these students who tend to populate peripherally located state medical faculties.

Ideology in the making

As health professionals leave en masse from the country, it is argued that private medical schools might present a solution for physician brain drain. The entry of private medical schools will surely create a two-tiered system with lasting impacts on who has access to medical education and on the healthcare system more broadly. Until now, state medical faculties have furnished the public health sector with its medical cadre. While there is certainly room for improvement, at this point, the focus should be on supporting state medical faculties to ensure the survival of the public health sector.

As welfare is steadily chipped away in the name of the economic crisis, the government, supported by sections of the elite, suggest that it is a ‘welfare mindset’ that has brought the country to this state of crisis. The media is drumming up support for the government’s short-sighted policies, including the dismantling of free education. Images of student protests are being deployed to further delegitimize state universities, detracting attention from the ongoing mass-scale dispossession that is taking place in this country, whether through ‘domestic debt optimisation’, labour reforms or the proposals on restructuring higher education and public health. In this context, opposing private medical education is portrayed as ‘ideological’ or impractical, concealing the ideological work that has been undertaken over the years to convince many to believe that fee-levying university education is the way forward.

(The author is attached to the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna)

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


Lingering world disorder and the UN’s role



The 9/11 Twin Tower horror in New York.

Russia could very well be questioning the legitimacy of the UN system by currently challenging the right of the International Court of Justice (ICJ) to arbitrate in the conflicting accusations of genocide brought against each other by it and Ukraine. Russia has countered Ukraine’s charge of genocide, occasioned by its invasion of Ukraine on February 24, 2022, by accusing the latter of perpetrating the same crime in the rebel region of Eastern Ukraine, which is seen as being within the Russian sphere of influence.

As is known, when Russia did not participate in a hearing sanctioned by the ICJ on the charge of genocide brought against it in March 2022, the ICJ called on Russia to halt the invasion forthwith. Russia, however, as reported in some sections of the international media, reacted by claiming that the ICJ has ‘no jurisdiction over the case since Ukraine’s request does not come within the scope of the Genocide Convention.’ The main sides to the Ukraine conflict are at present reportedly stating their positions in the ICJ with regard to the correctness of this claim.

Whereas, the law-abiding the world over would have expected the ICJ’s word to prevail in the Ukraine conflict, this does not seem to be the case. More precisely, it is the moral authority of the UN that is being questioned by Russia. Given this situation, the observer cannot be faulted for believing that Russia is ‘sticking to its guns’ of favouring a military solution in the Ukraine.

Considering the foregoing and the continuing lawlessness in other geographical regions, such as South-West Asia, the Middle East and parts of Africa, the commentator is justified in taking the position that little or nothing has been gained by the world community by way of fostering international peace over the decades.

Most distressing is the UN’s seeming helplessness in the face of international disorder, bloodshed and war. The thorny questions from the 9/11 New York twin-tower terror attacks, for instance, are remaining with humanity.

One of the most dreaded questions is whether the UN Charter has been rendered a dead letter by the forces of lawlessness and those wielders of overwhelming military might who couldn’t care less for moral scruples. Those state actors who display these traits risk being seen as destruction-oriented subversives or terrorists who are impervious to civilizational values.

Commentators are right when they point to the need for UN reform. This is, in fact, long overdue. Of the original ‘Big Five’ who went on to constitute the permanent membership of the UN Security Council (UNSC) at the end of World War 11 and who oversaw the establishment of the UN, only the US and China retain major power status in the true sense of the phrase today.

The rest of the original heavyweights cannot be considered ‘spent forces’, but there are other powers of more recent origin who could easily vie for their positions. Some of these are India, Brazil, South Africa, Turkey and Indonesia. Inducting some of the latter into the UNSC could help constitute a more globally representative UNSC. That is, they will help put together an UNSC which is more faithfully reflective of the current global power distribution.

Theoretically, a more widely representative and inclusive UNSC could be a check against the arbitrary exercise of power by the more ambitious, expansionary and authoritarian members of the UNSC but a foremost challenge facing the UN is to induce such new members of the UNSC into representing the vital and legitimate interests of the ordinary publics within these states and internationally. Minus such representation of the world’s powerless UN reform could come to nought. In fact, this could be described as a prime challenge before the UN which could decide its enduring relevance.

Admittedly, the challenge is complex and defies easy resolution. Not all the countries that are seen as prospective UNSC members are democratic in orientation. That is, they would not be people-friendly or egalitarian. Most of them are governed by power elites that are part of what has been described as the ‘Transnational Capitalist Class’ and could be expected to be repressive and parasitic rather than caring or egalitarian. How then could they be expected to be committed to re-distributive justice within their countries, for example?

In the short and medium terms, the UN system could bring into being systems and institutions that could make it comparatively difficult for the power elites of the world to be parasitic, exploitive, self-serving and unconscionable. Strengthening and giving added teeth to systems that could prove effective against money-laundering and allied practices of self-aggrandizement is one way out.

Ironically, it is perhaps the UN that could lay the basis for and provide these mechanisms most effectively and non-obtrusively. It would need to work more with governments and publics on these fronts and lay the foundation for the necessary accountability procedures within states. It should prepare for the long haul.

In the longer term, it’s the coming into existence of democracy-conscious governments and ruling strata that must be sought. Here too the UN could play a significant role. Its numerous agencies could prove more proactive and dynamic in inculcating and teaching the core values of democracy to particularly poor and vulnerable populations that could fall prey to anti-democratic, parochial political forces that thrive on division and discord.

UN aid could be even directly tied to the establishment and strengthening of democratic institutions in particularly impoverished countries and regions. Thus will the basis be laid for younger leaders with a strong democratic vision and programmatic alternative for their countries. Hopefully, such issues would get some airing in the current UN General Assembly sessions.

Accordingly, the broad-basing of the UNSC is integral to UN reform but the progressive world cannot stop there. It would need to ensure the perpetuation of the UN system by helping to bring into being polities that would respect this cardinal international organization which has as its prime aim the fostering of world peace. Democracy-conscious populations are an urgent need and systems of education that advocate the core values of democracy need to be established and strengthened worldwide.

The coming into being of rivals to the current Western-dominated world order, such as the BRICS bloc, needs to be welcomed but unless they are people-friendly and egalitarian little good will be achieved. Besides, undermining the UN and its central institutions would prove utterly counter-productive.

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Country Roads …concert for children



Sponsors and Country Music Foundation officials - from left: Dmitri Cooray (Jetwing), Maljini Jayasekera (Cargills), Feizal Samath (President CMF), Susaan Bandara (LOLC), Deepal Perera (SriLankan Airlines) and Spencer Manualpillai (Dilmah)

I’ve always wondered why those who have hit the big time in their profession, as singers, have not cared to reach out to the needy.

They generally glorify themselves, especially on social media, not only with their achievements, but also with their outfits, etc. – all status symbols.

I’m still to see some of the big names grouping together to help the thousands who are suffering, at this point in time – children, especially.

However, I need to commend the Country Music Foundation of Sri Lanka for tirelessly working to bring some relief, and happiness, to children, in this part of the world.

Country Roads is said to be Sri Lanka’s and South Asia’s longest running charity concert for children, and this year, they say, the show will be even better.

This concert has consistently donated 100% of its proceeds to children’s charities in Sri Lanka. Over the past 35 years, this has resulted in several million rupees worth of aid, all of which has contributed directly to addressing the most pressing issues faced by children in Sri Lanka, a common practice since the concert’s first edition was held in 1988.

In 2014, the concert contributed Rs. 500,000 to Save the Children Sri Lanka, to support its mother-and-child programme for local plantations. During the same year, another Rs. 100,000 was given to the Oxonian Heart Foundation, to help treat impoverished and destitute children suffering from heart disease, while a further Rs. 100,000 was donated to a poor family caring for a special needs child. In commemoration of its landmark 25th anniversary concert in 2013, CMF donated a million rupees to aid in a special UNICEF project.

Astrid Brook from the UK

The 2023 musical extravaganza will feature the bright lights and panoramic cityscape of Colombo, as its backdrop, as it will be held at the picturesque Virticle by Jetwing, which is situated high above the city, on the 30th floor of the Access Towers building, in Union Place, Colombo 2.

The 35th anniversary Country Roads concert for children will take place on Saturday, 7th October, 2023.

Feizal Samath, President of the Country Music Foundation (CMF), the concert organisers, commented: “We are very much looking forward to this event as it’s being held after a lapse of five years, due to unavoidable circumstances.”

Fan favourites the Mavericks from Germany and Astrid Brook from the UK will once again return to headline the 2023 concert, and joining them on stage will be local outfit Cosmic Rays, as well as the Country Revival Band, with Feizal and Jury.

Dirk (from the Mavericks) has this to say to his Sri Lankan fans: “2018 was the last time we were in your beautiful country with the Mavericks band. Then Corona came and with it a long break. I missed you very much during this time.

“It has now been five years since my last visit to Sri Lanka. A lot has changed. The sponsorship that has always made this trip possible for us is gone. But we didn’t just want to end this tradition, which we have learned to love so much since 1992. That’s why we’re travelling to Sri Lanka this year entirely at our own expense, because it’s an affair of the heart for us.

Mavericks from Germany

“We very much hope that it won’t be the last Maverick performance in Sri Lanka. We hope that this unique journey will continue, that there will also be a Country Roads concert in the years to come.”

The 35th anniversary edition of the Country Roads concert for children will be supported by Official Venue Virticle by Jetwing, and Official Airline SriLankan Airlines, as well as its other partners, Jetwing Colombo Seven, Cargills, LOLC, and Firefly.

Tickets are currently available, for a charitable donation of Rs 2,000 each, at Cargills Food City outlets at Kirulapone, Kohuwela (Bernards), Majestic City, Mount Lavinia (junction) and Staples Street.

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Healthy, Glowing Skin



Give your skin a boost by including the following into your diet:

* Avocados:

Avocados contain healthy fats which can help your skin stay moisturised and firm.

They also contain vitamin C and E – two important nutrients that your body need to support healthy skin and fight free radical formation.

Avocados are also rich in biotin, a B vitamin that some nutritionists believe can help promote healthy skin and hair. A deficiency of biotin can lead to skin problems, such as rashes, ache, psoriasis, dermatitis and overall itchiness.

* Carrots:

Carrots are rich in vitamin A, which fights against sunburns, cell death, and wrinkles. Vitamin A also adds a healthy, warm glow to your skin.

You can get vitamin A by consuming provitamin A through fruits, vegetables, and other plant-based products. Your body then converts beta-carotene into vitamin A to protect your skin from the sun.

Provitamin A can also be found in oranges, spinach, sweet potatoes, pumpkin, bell peppers, broccoli and more.

* Dark Chocolate:

Dark chocolate is beneficial for your skin because cocoa powder boasts a bunch of antioxidants. These antioxidants hydrate and smoothen your skin, making your skin less sensitive to sunburn and improves the blood flow of your skin. Make a healthy choice by opting for a bar of dark chocolate with 70% cocoa for more antioxidants and lesser added sugar.

* Green Tea:

Green tea has been said to protect the skin against external stressors and ageing. This is because it is antioxidant-rich and contains catechins that protect your skin, reduce redness, increase hydration, and improve elasticity.

A diet rich in antioxidants along with adequate hydration may even out your skin texture, strengthen your skin barrier and improve your overall skin health.

Avoid adding milk to green tea as the combination can reduce the effects of the antioxidants present in green tea.

Additional tips for healthy skin…

Don’t forget to stay hydrated because water plays a big part in the appearance of your skin. Water ensures your skin has enough moisture, which reduces the appearance of fine lines and wrinkles. It also helps with nutrient absorption, removal of toxins and blood circulation.

Besides food and water, it is important to observe proper hygiene. This means no touching your face until you’ve washed your hands. Your hands carry more bacteria than you think and the occasional touch here and there can add up. After a long day out, cleanse your face thoroughly.

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