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9th Janaury 2000

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Second opinion

The crisis looming for the medical profession

An apparently innocuous statement appeared in the media a few weeks ago, stating the President had directed the Minister of Higher Education to set up a new medical faculty at the South Eastern University.

As far as we are aware this decision is being acted upon and there have been no vociferous protests against it, save for a few tame words of dissent from the Sri Lanka Medical Association.

We also know that the decision to set up this faculty was taken in the context of the Presidential election which the President has now won. On the face of it, we have the Government Medical Officers Association (GMOA) arguing that Sri Lanka needs more doctors. Then, why protest at the setting up of another medical faculty which can provide more doctors every year?

But then, we do also have the government informing us that the state can no longer employ doctors except for a few more years. The medical profession, the last bastion where employment was guaranteed by the state, is in a state of collapse. If so, where will these new doctors work?

This curious paradox has arisen because of the unplanned and ill-coordinated development of the health and higher education sectors. Until a few decades ago, Colombo and Peradeniya were the only medical faculties in the country. Then, in quick succession new medical schools emerged at Galle, Jaffna, Ragama and Sri Jaywardenepura.

The last two in this list rose more by accident than design. The Ragama medical faculty was the product of the nationalization of the North Colombo Medical College and the Sri Jayewardenepura University had a medical faculty thrust upon it both decisions were largely political rather than academic in nature. Producing more medical graduates is a laudable move, but then it should be accompanied by parallel infrastructure development of the health sector state or private to absorb these graduates. Unfortunately, that was never done.

With more foreign qualified medical graduates returning to the country, friction has arisen between local and foreign-qualified graduates as the spectre of unemployment looms large in the medical profession. Very soon, we may well see doctors like other graduates staging 'upawaases' at every junction demanding jobs even when the state health sector is overworked and understaffed to extreme limits.

Recently, the government announced jobs would be guaranteed for doctors until the year 2010, following a revision of the cadre and a decision to employ them on a roster basis. Again, this appears to be an ad-hoc solution to what was beginning to be an embarrassing question for the government on the eve of an important election.

Taken in this context, the decision to set up a new medical faculty in the Eastern province is at best, naive. At worst, it is playing with the lives of the younger generation for petty political gains.

Ask any academic in any of the existing medical faculties about conditions in these medical schools and the answer would be the same: overcrowded, understaffed and therefore, mass-producing doctors of questionable quality in a bid to 'clear the backlog' of students who have completed their 'A' levels and are pounding on the doors of higher learning demanding their share of free education. So, how will the government stretch those meagre resources to accommodate another medical faculty? And even if it does, where will those graduates find employment?

Certainly, the state sector cannot be expected to provide jobs for doctors indefinitely. But it has a responsibility to do so until the doctor-patient ratio in government hospitals reaches an acceptable figure, when patients will be the ultimate beneficiaries with better care being given to them.

These are the issues that need to be looked into long and hard before issuing gazette notifications setting up new medical schools. That can be done with the stroke of a pen but the cataclysmic events that are triggered then take years to undo and even then the damage may be immense.

It is also unfortunate that responsible medical bodies such as the Sri Lanka Medical Council and trade unions such as the GMOA, which protest at the appointment of any single doctor, have not taken up the cause of medical education with the same zest with which they campaign for other issues.

After all, medical faculties and medical education will eventually affect the people at large because the doctors they produce will practise on them. It is therefore too serious a matter to be left to politicians alone!

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