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25th July 1999

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Medical graduates running out of state jobs

The medical commu- nity in this country, it appears, is never short of controversy. Only last week the Government Medical Officers' Association (GMOA) threatened to withdraw services yet again, over the proposed non-appointment of intern medical officers who have completed their period of training.

On the one hand, the government says it cannot provide jobs for all medical graduates being produced by our medical faculties- which now amount to over 750 a year, with the advent of the new medical school at Sri Jayewardenepura, as this page records elsewhere.

On the other hand, the GMOA points out that the doctor-patient ratio in this country is among the worst in Asia, a claim not contradicted by the Health Ministry.

An adverse doctor-patient ratio can only mean that a doctor in the course of his duty has to attend to more patients than ideal and the consequence is a lack in the standard of care provided to the patient. This malady apparently affects all levels of medical care in this country including specialised treatment- hence the crowds thronging the numerous private consultation centres turning them into marketplaces!

Where then lies the fault? It is obvious that while successive governments have increased opportunities for medical education as it was a politically lucrative investment, the same cannot be said of opportunities for healthcare for the poor. Moreover, there is still only minimal co-operation and consultation between the Health and Higher Education sectors.

It is indeed a stinging indictment on our governments that no major state hospital has been built in recent times without the assistance of an overseas donor. The result is that while the medical graduate population has grown exponentially, the infrastructure to absorb them has kept only a snail's pace.

Add to this, other factors such as foreign medical graduates returning for local employment and attempts to set up private medical schools and there is a perfect recipe for a cauldron of conflict. All of this is most unnecessary and can only jeopardize health services in the near future in the form of more strikes and protest campaigns.

Such is the short-sightedness of our health authorities that in the midst of all this there are attempts being made to continue the training of Assistant Medical Practitioners (AMPs), just because they seem to support the government whenever the GMOA launches a strike.

Surely, if the country can ill-afford to provide state jobs for doctors, why confound the matter by training lesser-qualified personnel for the same jobs? Is the government so suicidal as to desire more strikes and disputes in the health service?

Nevertheless, it must also be conceded that the state cannot continue to provide employment for all medical graduates indefinitely in the years to come. The government, no matter what it does, will eventually exhaust its capacity and then, doctors will have to look to the private sector for jobs-a situation now existing in India. But with an adverse doctor- patient ratio, it cannot be said that saturation point has been reached now.

It is also a fact that this situation has not arisen overnight, for a medical graduate is not produced in a day.

When the intakes to local medical schools were increased and new faculties set up, this could have been foreseen and remedial measures taken to increase the cadres in the state health sector, while those budding doctors were still in their lecture rooms.

Unfortunately, that was not done. As a result, junior doctors of today are paying the price for the follies of policy makers.

The situation has still not reached crisis point. Maybe it is not too late for the authorities to ponder over their statistics and project how many doctors will be produced in the next few years and offer them a reasonable chance of state employment. If such a remedy is not sought soon enough, Sri Lanka's already crippled state health sector could be confidently pronounced dead in a few years time.

Your heart is in good hands

By UdenaR . Attygalle

According to latest re- ports South Asians are most prone to heart attacks. So it is heartening that Durdans, a leading private sector hospital for the past 50 years, now has the latest equipment for its new heart centre.

The Durdans Escorts Heart Centre is operated in collaboration with the Escorts Heart Institute and Research Centre, New Delhi, India. The staff too received training there.

At present only two floors of the five-storey building are operational. Later Durdans will have facilities to carry out even bypass surgery.

The hospital provides a 24-hour ambulance service using a custom-made ambulance and has a channelling service dedicated wholly to cardiology with at least five cardiologists on call at all times.

If you suddenly get chest pains in the middle of the night and the ambulance is called, the ten-bed "Heart Command Centre" on the first floor is where you will be taken to. According to Upul Tudawa, executive director of the hospital, "the equipment installed includes the latest intra-areotic balloon pump and the surgical c^ arm for pace maker applications." In addition there are bedside monitors with a central console capable of monitoring vital parameters such as E.C.G. respiration/oxygen and carbondioxide saturation, invasive and none invasive blood pressure.

The heart station or the investigative unit is situated on the second floor. This unit deals with the diagnostic aspects of cardiology treatment. Patients with heart problems and those who have to get check-ups done can benefit from this section .

The stress ECG (treadmill) coupled with colour Doppler Hewlett Packard Sonos 18000 echo cardiogram is the only one of its kind in Sri Lanka. This gives four diagrams at once showing the heart before and after exercise which are then super imposed. This technology, Mr. Tudawe said, "is important for diagnosis and is non-invasive. Hence, it causes no discomfort to the patient plus no prior preparation is needed."

The hospital also has Morgan Lung function equipment that can monitor the lung condition of asthmatic and smoking heart patients.

These facilities will, no doubt, be a boon to the ever increasing number of heart patients in Sri Lanka.

Here come the doctors of J'pura

Come Friday, July 30, medical educa- tion in Sri Lanka will mark yet another milestone- the graduation of 126 new doctors from the country's sixth medical faculty, the Faculty of Medical Sciences at the University of Sri Jayewardenepura.

This momentous event, coming at a time when the medical profession is being subject to intense public scrutiny, is most welcome. For the fledgling faculty from its inception, has emphasized the values of the noble medical profession, quite apart from imparting the scientific know-how of the art of healing.

Indeed the latter too has been no easy task. At the outset, as one of the promoters of a medical school at Sri Jayewardenepura, the late eminent Professor Nandadasa Kodagoda observed wryly, "The university had a medical school thrust upon it; it was not born with it nor was it given time to plan and establish a medical school…"

The faculty had its teething problems. Finances, never easy to obtain, had to be found, staff had to be recruited and buildings had to be built to accommodate well over a hundred students every year.

"It was a challenge," says the Faculty's first Dean, Professor M. T. M. Jiffry, who has guided the destinies of the institution for the past five years. "But I knew that I had to uphold the confidence held in me by my colleagues as well as the students to develop this new faculty to its required standards…"

It has been somewhat of a rags-to-riches story since then. When 139 medical students started studies in 1993, their classroom was the Vice-Chancellor's bungalow. Students of the first intake- those who hold their convocation on Friday- recall with pride how they used to carry teaching equipment from lecture hall to lecture hall, begging and borrowing classrooms from other faculties.

Today the environment is different. A new building with state-of the-art facilities houses two departments of the Faculty. Phase two of this project is rapidly nearing completion.

A few miles away at the Colombo South Teaching Hospital, Kalubowila, a professorial unit has been added for students to undertake training in their final year of studies. This unit will be further expanded with financial aid from the Health Ministry and the assistance and kind co-operation of specialist doctors working at the Kalubowila Hospital have been readily forthcoming, says a grateful Professor Jiffry.

The new Medical Faculty has also been fortunate in that it was the recipient of a grant from the Japan International Co-operation Agency (JICA) in the form of modern equipment necessary for student teaching and patient care. And, reciprocating the gesture of goodwill from the Ministry of Health the University now uses some of this equipment jointly with Health Ministry staff at the Colombo South Hospital.

Being the beneficiary of all these facilities, the faculty has not only tried to produce doctors of quality, it has also tried to be different and some of those attempts are worthy of mention.

Medical students of the Faculty have disowned ragging from the inception and it has stayed that way since then. They have also formed an 'Art Circle' which organises many a cultural event and collaborates with the other faculties in the campus, demonstrating that the interests of students are not purely medical or academic.

Then, the Faculty plans to offer degree programmes in fields allied to the health sciences such as nursing, pharmacy and medical laboratory technology. Hence the Faculty is styled the 'Faculty of Medical Sciences' and that would be a first in this country.

But the Faculty also knows its limitations, especially in fields where there is a countrywide dearth of qualified university teachers. "So, we are fortunate to have established cordial relationships with all other faculties. Especially, the academic staff of the Colombo Medical Faculty have always extended their assistance whenever we needed them," Professor Jiffry explains.

But buildings, facilities and knowledge are not the only ingredients of a successful medical education programme, a fact readily acknowledged by the staff of the faculty- they are unanimous in their opinion that the ultimate aim must be to produce a dedicated and caring doctor.

Nevertheless, all these efforts have not gone unnoticed. At a time when the quality of medical education is being subjected to critical evaluation the Faculty passed its first real test: The MBBS degree to be conferred on the graduands from the Sri Jayewardenepura University was recognized by the Sri Lanka Medical Council, the body empowered to do so.

For the university authorities though, it is only the first hurdle that has been overcome. Professor Jiffry hopes that his ambitious plans for the faculty can be continued under the tenure of Prof. J. W. Wickramasinghe who recently assumed duties as Vice- Chancellor, succeeding Prof. P. Wilson.

For 126 graduates the long, hard road to a bachelor's degree in medicine will be over on Friday, when at a Special Convocation, they receive their cloaks from President Chandrika Kumaratunga.

But for Professor Jiffry and his academic staff at this new Faculty it is only the end of the beginning. They know that another 800 students are under their care now, in seven batches. They have many promises to keep.

But, if the recent past is anything to go by those students need not worry too much. They may rest assured that they are in safe hands.

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