Over the past years, the Government Medical Officers Association (GMOA) has declared war against the South Asian Institute of Technology and Medicine (SAITM) and demanded SAITM be closed down and later changed the demand to be taken over by the Government. 

The GMOA’s reasons for taking over SAITM are the lower education qualifications of admitted students compared to Government Medical Colleges and the poor quality of clinical training offered to their students. GMOA does not comment on teaching facilities and quality of lecturers in SAITM. 

Meanwhile, the GMOA turned a blind eye on educational and clinical facilities offered at the Medical Faculty of Eastern University, Batticaloa, which has delivered over 200 doctors since 2013.

Eastern University, Faculty of Health Care Sciences
Details of the Faculty are available in the comprehensive website www.fhcs.esn.ac.lk and data given below were obtained from the website (last updated in 2017). The writer’s comments are given afterwards. 

History
The concept of establishing a Faculty of Health Sciences arose in the nineties and in 1993 late President R. Premadasa elevated the Provincial Hospital, Batticaloa as a Teaching Hospital. A Medical Faculty Committee comprised of academics, Medical Educationists, clinicians existed since early 1990s. Post Basic Diploma in Nursing began in 1998 and continued up to 2002. An Interim Faculty Board functioned since 2003 until the establishment of the Faculty. 

The Faculty of Health Care Sciences of the Eastern University was established by a Gazette notification dated 23 November 2005, with six Departments and the first dean was Dr. K. E. Karunakaran, an obstetrician and gynaecologist attached to Teaching Hospital, Batticaloa.

Message from Dean 
Sri Lanka is a nation which boasts remarkable achievements in healthcare statistics in the region. However, until recently, only the profession of doctors was considered worthy of a degree from a university. This feature is quite contrast to the developed world and other developing countries where almost all health-care professions have recognised degrees. The uniqueness of each field has to be recognised and respected in order to achieve high standards. 

The faculty offers two courses of studies: Medicine (MBBS) and Nursing (BSc). The first batch of students for MBBS programme was enrolled in 2006 and the same has graduated with flying colours in 2013. Many of our MBBS graduates have been selected for post graduate training in different specialties. Six and five academic staff members were able to complete their PhD degrees and masters respectively after joining the faculty. 

Challenges
The two major challenges we face today are lack of permanent buildings and inability to recruit medical professionals, especially consultant specialists from state service due to policies of the Ministry of Health. Recently, however the Government has taken special interest in the FCHS, and measures have been taken to expedite the building processes at Pillaiyarady and Teaching Hospital, Batticaloa.

Gratitude
I wish to express my sincere gratitude towards the Deans of Medical Faculties from the Universities of Colombo, Kelaniya, Sri Jayewardenepura, Peradeniya, Jaffna, Ruhuna, Rajarata and Kotelawala Defence Academy for lending the services of their professors and senior lecturers who help us wholeheartedly in teaching activities and assessments. The support rendered by the Director and the staff of Teaching Hospital Batticaloa cannot be overstated.

Sgd. Dr. Angela Arulpragasam Anthony MBBS (Jaffna), MD (Paediatrics) (Colombo)
Dean, Faculty of Health-care Sciences
Eastern University, Sri Lanka
Medical education

www.fhcs.esn.ac.lk

The Faculty of Health-Care Sciences (FHCS) at Eastern University was established in 2005 and the B.Sc in Nursing has been conducted since 2008 together with success. The first set of students to read for MBBS degree walked in on June 2006. Attempts have been made to have sessions common to both MBBS and B.Sc Nursing programmes currently.

Major successes for FHCS:

• During the initial years of 2005, 2006 and 2007 handful of academic and non-academic staff were recruited to function at the Faculty when students began to get enrolled. It was their unprecedented dedication and application that initiated the success of this faculty. 
• The entire batch of 27 students recruited as the first batch of this faculty, got through the Phase III (Final) MBBS examination in their first sitting itself. Furthermore, when students sat for the common MCQ paper to be ranked by the University Grants Commission to formulate the common merit list. One of our students was ranked 12th and three more students were within the first 40. The performance of the 2nd batch of students were almost similar except that, two students had to complete the Phase III (Final) in their 2nd attempt.

Student’s Handbook
To date, the FHCS has produced about 200 medical and 75 nursing graduates all of whom are providing their professional services in the country. Many of our MBBS graduates have been selected for post-graduate training in different specialties offered by the Postgraduate Institute of Medicine, University of Colombo.

In 2006, Dr. K.E. Karunakaran, an obstetrician and gynecologist, joined as a senior lecturer and later elected as the founder Dean of the Faculty. During his period, 50 acres of land and buildings at Pillaiyarady was acquired from the Paddy Marketing Board for the faculty and a master plan prepared. Existing buildings were renovated and new buildings are being constructed. Phase I of the University Units in the hospital is completed awaiting occupation and the Phase II plan is being drawn out. 

Presently the hostels accommodating the students of FHCS function at Pillaiyarady. In addition funds were approved to construct University Teaching Unit (UTU) at Teaching Hospital, Batticaloa. 

Undergraduate MBBS Programme
The duration of MBBS programme is 10 semesters and the medium of instruction is English. The learning methods used in this programme include formal lectures, demonstrations, clinical attachments, tutorials, Small Group Discussions (SGDs), Problem Based Learning (PBLs), Inter-Professional Educational Activities, student seminars, assignments, debates, family attachments, field based projects and research.

Assessment – MBBS Programme
The examination system is based on Overall Grade Point Average (OGPA). MBBS programme has 10 semesters with four summative assessments. Examination system is based on Overall Grade Point Average (OGPA). The evaluation is through continuous modular and terminal assessments, where emphasis is placed on feedback and counselling.
1. Phase I Assessment at the end of 3rd Semester
2. Phase II (Part-I) Assessment at the end of 5th Semester
3. Phase II (Part – II) Assessment at the end of 8th Semester
4. Phase III Assessment at the end of 10th Semester

In addition to above following compulsory modules should be completed by a student to be awarded the MBBS degree.
ME 1201: Proficiency in English Level I 
ME 1202: Proficiency in Computer Literacy and Information Technology 
ME 1203: Basic Tamil/Sinhala 
ME 2101: Proficiency in English Level II
ME 3101: Peace Medicine

Based on continuous assessment and grade points
To be eligible for a class or distinction, the candidate should have attempted the Phase Assessment in the first attempt and appeared for all the Units pertaining to the Phase Assessment at one sitting. 

Departmental Heads
The qualifications of respective heads of Departments of Medical Faculty are given below, names are withheld but are on the website.
1. Department of Human Biology, Head, Dr. …….B.Sc Hons (Human Biology), PhD (Col) Senior Lecturer Gr.II
2. Department of Pathophysiology, Coordinator, Ms. ……. BSc, MSc(India), Sc Applied Microbiology (KLN), Lecturer (Prob) in Microbiology
3. Department of Primary Health Care, Head (Cognate) Dr. ………. B.Sc Hons (Human Biology), M.Sc (Col), PhD (Col). Senior Lecturer Gr.II
4. Department of Clinical Sciences, Head Dr. ……… MBBS (Jaf), MD (O & G) (Col.),  Senior Lecturer Gr.II
5. Department of Supplementary Health Sciences, Head Rev. Sr. Dr. …….. Dip. in Nursing, BSc Nursing, MSc Nursing, Ph.D (Com. Med); Senior Lecturer Gr.I in Nursing
6. Department of Medical Education and Research, Head Mr. ……… Attorney at Law, BSc Hons (Chemistry) (EUSL), PGDip. Med.Ed (Colombo), PGDE (OUSL), MEd (EUSL), LLB. (OUSL), M.Phil (UoP), Senior Lecturer Gr.II

Formulation of credits to MBBS Programme
The entire batch of students (27 in number) recruited as the first MBBS batch of the faculty, got through the Phase III (Final) MBBS examination in their first sitting itself. Furthermore, the students had to sit the common MCQ paper with which the graduates were ranked by the University Grants Commission to formulate the common merit list. One of our students was ranked 12th and three more students were within the first 40. The performance of the 2nd batch of students too were almost at the level of 1st batch except that, two students had to complete the Phase III (Final) in their 2nd attempt, in the same academic year.

BSc Hons (Nursing) Programme
The duration of the programme is eight semesters (four years). The medium of instruction is English. The first batch of students for BSc. Nursing commenced in 2008. All graduates serve in the Government and private healthcare sectors and many have joined the academic fields too. 

Teaching Hospital, Batticaloa
The Teaching Hospital, Batticaloa, is the major tertiary care institution in the Eastern Province. It serves a population of more than two million living in the Batticaloa District and adjoining Districts such as Ampara and Trincomalee. It has the capacity of 35 wards and 931 beds. The average number of OPD patients is around 700 per day and clinic patients more than 650 per day. Around 600 deliveries and more than 750 surgeries are performed monthly. Around 35 medical specialists attend this institution.

The Faculty of Healthcare Sciences of the Eastern University, established in 2004 with six departments, currently, 425 students follow degree courses in medicine, surgery, and nursing. The faculty is currently situated in a building that is temporarily taken over from the Paddy Marketing Board.

The Ministry of University Education has estimated the cost of constructing the new building complex as $ 47.3 million (Rs. 6,617.5 million) out of which $ 34 million will be granted as a concessionary loan by the Kuwait Fund for Arab Economic Development (KFAED).

The University claims in World University Rankings they stand at 6,408.

Anuradhapura Medical College
According to their website, the first batch of 171 medical undergraduates from 22 districts of the island was enrolled in 2006. This included 38 students displaced from the Faculty of Medicine of the Eastern University of Sri Lanka. The first batch of MBBS graduates have passed out from the Faculty in 2012. According to the Website University had two Professors in 2011 (website year).

Discussion
Admission to Medical Colleges are based on the Z score and the district quota system. The system allows rural district students with very much lower marks to become eligible to enter a Medical Faculty. The students are allocated medical colleges based on their Z score and the student’s wish. Poor facilities at Eastern University is well known and the Faculty of Health Care Sciences (EUFH) admits students with lowest marks. 

According to the Dean, EUFH currently 10 years after establishing, the Faculty lacks permanent buildings and medical professionals. None of the six departments are headed by a Professor, so is the Dean. Most teaching is conducted by Professors and Senior Lecturers from other Medical Faculties. Students at EUFH complain that they idle the entire week and external lecturers arrive over the weekend. The visiting lecturers conduct lectures for four hours in the morning and another lecturer in the evening. How effective are the lectures and how much can the students take-in during the marathon lectures over two days? 

Clinical training of EUFH is done in the Batticaloa Hospital under the hospital staff. Or do the visiting professors too get involved in clinical training? When so many lecturers from different institutions do the teaching and training who does the coordination and ensures no gaps?

During the initial years of 2005, 2006 and 2007 handful of academic and non-academic staff were recruited to EUFH while students were enrolled. But the entire first batch of 27 students who scored lowest Z score at AL passed the Phase III (Final) MBBS examination in their first sitting. The Faculty located in an old Paddy Marketing property, lacked buildings, facilities, professors and lecturers, but the entire batch passed the Finals; can these results be acceptable as fair? These doctors are employed in Government hospitals and today, must be members of GMOA.

In other medical colleges examination papers are prepared only by professors, and EUFH has none. But they circumvented the situation, by implementing an examination system based on Overall Grade Point Average (OGPA), which the Faculty claims was accepted by the University Grants Commission. The Grade Point system allows continuous assessment of students, but who does the assessment and how qualified are the examiners?

Meanwhile, SAITM in their website shows a long list of teaching staff including 14 full time and 13 visiting professors. They claim the final examination in SAITM is based on exam marks 70%, viva voce 10% and credit tests at end of semesters 20%. 

Anuradhapura Medical College started 2 years after EUFH has only two professors, but were allocated better funding for buildings for their Anuradhapura teaching hospital. It is a known fact that Rajapaksa Government refused to allocate funds to Batticaloa-based EUFH. In addition professors are reluctant to accept appointments in locations lacking private hospitals that avail private practice. I am aware of a medical specialist attached to Batticaloa hospital, who every Friday night takes the bus to Colombo to carryout private practice over the weekend and returns on Sunday night.

GMOA attacks SAITM for poor quality medical graduates becoming doctors and demand they be unacceptable, but have they visited Batticaloa Medical Hospital or at least visited their website; or are they blind to the unacceptable truth for their benefit? 

When lack of proper clinical training of SAITM students was highlighted, the Supreme Court following a petition by SAITM students ordered Health Ministry to allow training in Kaduwela and Avissawella base hospitals on a payment of Rs. 50,000 per student. However, GMOA refused to allow training. Now who is responsible for SAITM students’ poor clinical exposure? GMOA President Padeniya, who was attached to Anuradhapura Hospital, must be aware of facilities and conditions in the hospital. It is clear that GMOA has double standards with respect to Eastern University Medical College and SAITM.

Presently children from Government schools having studied in Swabasha enter the Medical Colleges and among most of them English proficiency continues to be poor even after graduation. When SAITM gets accepted, students from international schools too would join and students with better English would get preference for further training in British hospitals. GMOA is scared of competition.

As the Dean of Eastern Medical College stated: “In developed world and other developing countries almost all healthcare professions have recognised degrees.” But GMOA has been obstructing training of paramedical students; they also hinder providing four year training to nurses. It is clear GMOA demands monopoly in healthcare for their personal gain.

The website of Rajarata University of Sri Lanka, extracted from the statement of Dean, Faculty of Medicine and Allied Sciences, Sisira Siribaddana MBBS, MD, FCCP, FRCP Edin; I quote: “Medical education is at crossroads in Sri Lanka. Private and defence medical colleges with budgets more than the total Higher Education Ministry allocation are being established. Newly-established and under-resourced medical faculties and these newly-established but over-resourced and well-established medical faculties may give rise to two-tier medical education in Sri Lanka.”

Pix by Shehan Gunasekara

Published in the Daily FT on 20 July 2017